Cesarean Deliveries Among Immigrant and Canadian-Born Women in a Representative Community Population in Canada: A Retrospective Cohort Study

ObjectiveTo examine differences in the rate of cesarean delivery between Canadian-born women and immigrants to Canada and by duration of time in Canada and rate of cesarean delivery in their country-of-origin.MethodsWe used linked data from hospitalization records and the Canadian Community Health Survey for all deliveries after 20 weeks gestation between 2002 and 2017 in Canada (excluding Québec). Odds of cesarean delivery in recent immigrants (<5 y in Canada) and non-recent immigrants (≥5 y in Canada) were compared with those of Canadian-born women using multivariable logistic regression. Immigrants were further categorized using the cesarean delivery rate in their country-of-origin as low (<10%), medium (≥10 to <35%), or high (≥35%).ResultsOf the 53 505 women included, 89% were Canadian-born, 4% were recent immigrants and 7% were non-recent immigrants. Overall, 28.6% of women had a cesarean delivery. After adjusting for medical and socio-economic factors, the odds of cesarean delivery among recent immigrants (OR 1.12; 95% CI 0.95–1.34) and non-recent immigrants (OR 1.11; 95% CI 0.98–1.25) did not differ statistically from those of Canadian-born women. Recent immigrants from countries with lower cesarean delivery rates had higher odds of cesarean delivery (OR 1.34; 95% CI 1.05–1.70), whereas the odds of cesarean for recent immigrants from medium- and high-rate countries did not differ from those of Canadian-born women.ConclusionAfter accounting for demographic and medical factors, few differences remained in cesarean delivery rates between immigrants and Canadian-born women. Country-of-origin practices are unlikely to reflect preferences for cesarean delivery in immigrant women in Canada.     

五年剖宫产率及指征的变化分析

目的:探讨徐州医学院附属第三医院近五年剖宫产率升高的原因。寻找降低剖宫产的措施与方法,以期降低剖宫产率,保障母婴健康。方法:回顾性分析2006年1月至2010年12月,在徐州医学院附属第三医院住院分娩的3430例病例,其中剖宫产1608例,占46.88%。结果:无明显医学指征为首位。结论:合理掌握剖宫产指征,是降低剖宫产率的关键。     

新式剖宫产382例临床分析

目的 评价新式剖宫产术式的优点。方法 分析３８２例新式剖宫产产妇术中、术后情况,并与同期上剖宫产及子宫下段剖宫产比较,观察手术时间、出血量、娩头难易、术后进食时间及排气时间等。结果 新式剖宫产较腹膜外剖宫产从开腹到娩胎儿时间平均缩短１０．１ｍｉｎ（Ｐ〈０．０１）,出血量平均减少２８ｍｌ（Ｐ〈０．０５）,且娩胎头容易,较子宫下段剖」宫产手术时间平均缩短１２ｍｉｎ（Ｐ〈０．０１）,术后进食平均早１１．     

Unsuccessful trial of labor in women with and without previous cesarean delivery

Objective.?To compare maternal and neonatal outcomes after unsuccessful labor in women with and those without prior cesarean delivery.

Methods.?This was a retrospective cohort study of all women in labor delivered by cesarean section (CS) from November 2004 through December 2006. The study population was dichotomized by previous CS and compared for various maternal and neonatal outcomes. Student t-test, χ² and Fisher exact tests were used for analysis.

Results.?There was a significantly higher rate of symptomatic uterine rupture [3/100 (3%) vs. 0/449 (0%), p?=?0.006], asymptomatic uterine scar dehiscence [6/100 (6%) vs. 0/449 (0%), p?=?0.0001], and bladder injury [2/100 (2%) vs. 0/100 (0%), p?=?0.001], among women with prior cesarean delivery compared to those without. The rate of respiratory distress syndrome [(6/100) (6%) vs. 10/449 (2.2%), p?=?0.05] and meconium aspiration [4/100 (4%) vs. 2/449 (0.4%), p?=?0.01] was also significantly higher among neonates of women with prior cesarean delivery. However, the rate of endomyometritis [3/100 (3%) vs. 50/449 (11.1%), p?=?0.009] and febrile morbidity [17/100 (17%) vs. 144/449 (32.1%), p =?0.003] was significantly lower among women with prior cesarean delivery compared to those without prior cesarean birth.

Conclusions.?Compared to laboring women without previous cesarean delivery, women with previous cesarean delivery have increased maternal and neonatal morbidity. Febrile morbidity was, however, lower among women with previous cesarean delivery. These differential findings should further inform our perinatal counseling of women contemplating trial of labor after a previous cesarean delivery.     

延迟钳夹脐带对剖宫产新生儿早期血液灌输的影响研究

目的　探讨延迟钳夹脐带对剖宫产新生儿早期血液灌输的影响。方法　2007年7月至2009年9月东莞石龙博爱医院产科经剖宫产分娩的137例新生儿随机分成两组,即常规钳夹脐带组（71例）和延迟钳夹脐带组（66例）。比较分析两组剖宫产新生儿的钳夹脐带时间、生后48 h血常规及生后3d内静脉血胆红素值和贫血的发生率。结果　两组剖宫产新生儿钳夹脐带时间、生后48 h内血常规指标及贫血发生率的比较差异有统计学意义（P < 0.05）,延迟钳夹脐带组贫血发生率减少。结论　延迟钳夹脐带对剖宫产新生儿早期血红蛋白（Hb）、红细胞压积（HCT）有显著影响,可减少剖宫产新生儿早期贫血的发生率。     

剖宫产后再次妊娠的阴道分娩

近年来剖宫产率在我国不断升高,有些城市已从20年前的9%上升到45%.造成剖宫产率升高的原因很多,例如惧怕分娩、胎儿电子监护的广泛使用、对臀位产缺乏训练和经验、阴道手术产的减少以及再次剖宫产的增多等.减少过高的剖宫产率的办法之一就是剖宫产史孕妇经阴道试产.     

剖宫产后阴道试产的产时及产后评估

目的:探讨剖宫产后阴道试产(TOLAC)患者自然临产时及产后的评估及监测。方法:选择四川大学华西第二医院产科就诊的成功剖宫产后阴道分娩的患者42例(VBAC组),及同期就诊的瘢痕子宫急诊剖宫产患者50例(CS组)和阴道分娩的初产妇50例(正常分娩组)为研究对象,对3组患者的母儿相关情况进行比较。结果:3组患者的年龄、孕周、孕前体质量指数(BMI)及妊娠合并症情况比较,差异无统计学意义(P0.05),VBAC组胎儿双顶径(BPD)小于其他两组(P0.05),宫颈Bishop评分高于其他两组(P0.05)。与正常分娩组比较,VBAC组产后2小时内出血量多(P0.05),但产后2~24小时内出血量和新生儿5分钟Apgar评分差异无统计学意义(P0.05)。与CS组比较,VBAC组患者24小时出血量少且住院天数短(P0.05),而新生儿5分钟Apgar评分差异无统计学意义(P0.05)。结论:自然临产后,胎儿双顶径较小且宫颈成熟度较高的瘢痕子宫患者可以进行阴道试产,与再次剖宫产相比可以减少产后出血量及住院天数。在TOLAC过程中需要动态观察,严密监护,尤其要注意预防产时和产后2小时出血。     

Vaginal birth after cesarean section: Experience from a regional hospital

ObjectiveTrial of labor after cesarean section (TOLAC) is an option for women with previous cesarean section. However, few women choose this option because of safety concerns. We evaluate the safety and risks associated with TOLAC and the success rate of vaginal birth after cesarean delivery (VBAC).Material and methodsWe reviewed all patients with a history of previous cesarean section that underwent elective repeat cesarean section (ERCS) or TOLAC in a regional teaching hospital from Nov, 2013 to May, 2018. Maternal basic clinical information, intrapartum management, postpartum complications, and neonatal outcomes were analyzed.Results199 pregnant women with a history of at least one previous cesarean section were enrolled. 156 women received ERCS and 43 women (21.6%) underwent TOLAC, with 37 (86.0%) who underwent successful VBAC. The VBAC rate was 18.6%. Higher success rate was found in women with previous vaginal birth than in women without vaginal birth (100% vs. 81.8%). One case (2.3%) in the VBAC group was complicated with uterine rupture and inevitable neonatal death during second stage of labor. The uterus was repaired without maternal complications. In another case, the newborn's condition was complicated with low APGAR score (<7) at birth due to maternal chorioamnionitis. Among indications for previous cesarean section, cephalo-pelvic disproportion (CPD) was associated with TOLAC failure and uterine rupture after VBAC.ConclusionVBAC is a feasible and safe option. Modes of delivery should be thoroughly discussed when considering TOLAC for women with history of previous cesarean section due to CPD, considering its association with TOLAC failure in second stage of labor.     

Late preterm birth and previous cesarean section: a population-based cohort study

Background: Late preterm birth (LPB) is increasingly common and associated with higher morbidity and mortality than term birth. Yet, little is known about the influence of previous cesarean section (PCS) and the occurrence of LPB in subsequent pregnancies. We aim to evaluate this association along with the potential mediation by cesarean sections in the current pregnancy.

Methods: We use population-based birth registry data (2005–2012) to establish a cohort of live born singleton infants born between 34 and 41 gestational weeks to multiparous mothers. PCS was the primary exposure, LPB (34–36 weeks) was the primary outcome, and an unplanned or emergency cesarean section in the current pregnancy was the potential mediator. Associations were quantified using propensity weighted multivariable Poisson regression, and mediating associations were explored using the Baron-Kenny approach.

Results: The cohort included 481,531 births, 21,893 (4.5%) were LPB, and 119,983 (24.9%) were predated by at least one PCS. Among mothers with at least one PCS, 6307 (5.26%) were LPB. There was increased risk of LPB among women with at least one PCS (adjusted Relative Risk (aRR): 1.20 (95%CI [1.16, 1.23]). Unplanned or emergency cesarean section in the current pregnancy was identified as a strong mediator to this relationship (mediation ratio?=?97%).

Conclusions: PCS was associated with higher risk of LPB in subsequent pregnancies. This may be due to an increased risk of subsequent unplanned or emergency preterm cesarean sections. Efforts to minimize index cesarean sections may reduce the risk of LPB in subsequent pregnancies.     

Examining the role and relevance of the critical analysis and comparison of cesarean section rates in a changing world

Cesarean section (CS) is one of the most commonly performed surgical operations in the world and has resulted in improved maternal and neonatal morbidity and mortality rates internationally. However, concerns have been raised regarding the ever increasing CS rates to what has been described as ‘epidemic’ proportions. Global CS rates have increased from 6.7% in 1990 to 19.1% in 2014. However, there is a vast variation in the CS rates between countries with CS rates of 44.3% reported across Latin America & the Caribbean and CS rates as low as 4.1% in central and West Africa. There is much controversy regarding the optimal figure for CS in a population. The optimal CS rates for a population have been recommend in various studies, ranging from 10% to 19%, above which no reported improvement in maternal and neonatal mortality rates is observed. This review examines the evolution of the changing indications for CS and increasing CS rates in a world where family sizes are reducing and maternal age at first pregnancy is increasing. Efforts must be made to agree on an appropriate classification system whereby CS rates can be compared accurately between units and countries as a useful tool to audit and monitor our practice. Obstetricians should consider the indications for each CS performed, be conscious of the CS rate in our own countries and institutions and most importantly, be cognizant of how the CS rate impacts the maternal and perinatal morbidity and mortality rates and adjust our practice accordingly, to minimize harm.     

Cesarean and Vaginal Birth in Canadian Women: A Comparison of Experiences

Abstract: Background: Many publications have examined the reasons behind the rising cesarean delivery rate around the world. Women’s responses to the Maternity Experiences Survey of the Canadian Perinatal Surveillance System were examined to explore correlates of having a cesarean section on other experiences surrounding labor, birth, mother‐infant contact, and breastfeeding. Methods: A randomly selected sample of 8,244 estimated eligible women stratified primarily by province and territory was drawn from the May 2006 Canadian Census. Completed responses were obtained from 6,421 women (78%). Results: Three‐quarters of the women (73.7%) gave birth vaginally and 26.3 percent by cesarean section, including 13.5 percent with a planned cesarean and 12.8 percent with an unplanned cesarean. In addition to more interventions in labor, women who had a cesarean birth after attempting a vaginal birth had less mother‐infant contact after birth and less optimal breastfeeding practices. Conclusion: Findings from the Maternity Experiences Survey indicated that women who have cesarean births experience more interventions during labor and birth and have less optimal birthing and early parenting outcomes. (BIRTH 37:1 March 2010)     

Cervico-isthmic pregnancy ending with the delivery of a live-born infant in late second trimester

A very rare case of cervico-isthmic pregnancy, terminated by cesarean section in late second trimester with the delivery of a live-born infant who subsequently remained alive, is described. The authors suggest that this is the first case of neonatal survival in late second trimester of a cervico-isthmic pregnancy.     

Elective Cesarean Delivery: Does It Have a Negative Effect on Breastfeeding?

Abstract: Background: Cesarean delivery has negative effects on breastfeeding. The objective of this study was to evaluate breastfeeding rates, defined in accordance with World Health Organization guidelines, from delivery to 6 months postpartum in infants born by elective and emergency cesarean section and in infants born vaginally. Methods: Delivery modalities were assessed in relation to breastfeeding patterns in 2,137 term infants delivered at a tertiary center, the Padua University School of Medicine in northeastern Italy, from January to December 2007. The study population included 677 (31.1%) newborns delivered by cesarean section, 398 (18.3%) by elective cesarean, 279 (12.8%) by emergency cesarean section, and 1,496 (68.8%) delivered vaginally. Results: Breastfeeding prevalence in the delivery room was significantly higher after vaginal delivery compared with that after cesarean delivery (71.5% vs 3.5%, p < 0.001), and a longer interval occurred between birth and first breastfeeding in the newborns delivered by cesarean section (mean ± SD, hours, 3.1 ± 5 vs 10.4 ± 9, p < 0.05). No difference was found in breastfeeding rates between the elective and emergency cesarean groups. Compared with elective cesarean delivery, vaginal delivery was associated with a higher breastfeeding rate at discharge and at the subsequent follow‐up steps (7 days, 3 mo, and 6 mo of life). Conclusions: Emergency and elective cesarean deliveries are similarly associated with a decreased rate of exclusive breastfeeding compared with vaginal delivery. The inability of women who have undergone a cesarean section to breastfeed comfortably in the delivery room and in the immediate postpartum period seems to be the most likely explanation for this association. (BIRTH 37:4 December 2010)     

Self-inflicted cesarean section with maternal and fetal survival.

An unusual case of self-inflicted cesarean section with maternal and child survival is presented. No similar event was found in an Internet literature search. Because of a lack of medical assistance and a history of fetal death in utero, a 40-year-old multiparous woman unable to deliver herself alone vaginally sliced her abdomen and uterus and delivered her child. She was transferred to a hospital where she underwent repair of the incisions and had to remain hospitalized. Mother and child survived the event. Unusual and extraordinary measures to preserve their offspring sometimes moves women to extreme decisions endangering their own lives. Social, educational, and health measures should be instituted all over the world, particularly in rural areas of developing countries, to avoid such extreme events.     

剖宫产出血129例临床分析

目的探讨剖宫产出血的原因及剖宫产指征与剖宫产出血的关系。方法对1999年7月-2005年6月行剖宫产出血的129例临床资料进行回顾性分析。结果129例剖宫产出血病例中，宫缩乏力81例，占62．79锈；胎盘因素30例，占23．26％；切口撕裂3例，占2、33％；晚期产后出血1例，占0．78％。社会因素为指征的剖宫产出血16例，占12．40％。结论剖宫产出血率明显高于阴道分娩出血率；官缩乏力是剖官产出血的首要因素；社会因素的剖官产出血应引起社会和医务人员的重视。     

Post-cesarean adhesions–are they a unique entity?

Objective. The connection between adhesions and post-operative symptoms is well established. Adhesions are found in nearly half of the women at the time of their repeat cesarean section. For the first time a prospective pilot study has been done in order to evaluate the clinical significance of post-cesarean adhesions.

Study design. Fifty women who underwent cesarean section in their first pregnancy were interviewed prior to their repeat operation regarding their symptoms after the first surgery. The clinical history was correlated with the findings during the second intervention.

Results. No correlation was found between the clinical symptoms and the operative findings regarding abdominal pains, urinary symptoms, dyspareunia, or dysmenorrhea. Surprisingly, although non-significant, women with adhesions reported fewer postoperative gastrointestinal symptoms than the women with no adhesions.

Conclusion. More studies will have to been done, but the analysis of this pilot study supports the hypothesis that adhesions following cesarean section are a unique entity.     

剖宫产子宫瘢痕憩室诊断和治疗进展

<正>近年来我国较高的剖宫产率导致了很多近远期手术相关问题,这些问题对子宫的影响乃至再次妊娠都带来一定危害,其中剖宫产子宫瘢痕憩室的形成就是我们必须面对的一个重要问题。剖宫产子宫瘢痕憩室又称剖宫产术后子宫瘢痕缺损(previous cesarean scar defect,PCSD),是指子宫下段剖宫产术后的子宫切口处形成一个与宫腔相通的憩室,由于憩室下端瘢痕的活瓣作用阻碍了经血的引流,从而出现一系列临床相关症状[1]。关于