Review

Authors: Clarel Antoine, Bruce K Young

In present-day obstetrics, cesarean delivery occurs in one in three women in the United States, and in up to four of five women in some regions of the world. The history of cesarean section extends well over four centuries. Up until the end of the nineteenth century, the operation was avoided because of its high mortality rate. In 1926, the Munro Kerr low transverse uterine incision was introduced and became the standard method for the next 50 years. Since the 1970's, newer surgical techniques gradually became the most commonly used method today because of intraoperative and postpartum benefits. Concurrently, despite attempts to encourage vaginal birth after previous cesareans, the cesarean delivery rate increased steadily from 5 to 30-32% over the last 10 years, with a parallel increase in costs as well as short- and long-term maternal, neonatal and childhood complications. Attempts to reduce the rate of cesarean deliveries have been largely unsuccessful because of the perceived safety of the operation, short-term postpartum benefits, the legal climate and maternal request in the absence of indications. In the United States, as the cesarean delivery rate has increased, maternal mortality and morbidity have also risen steadily over the last three decades, disproportionately impacting black women as compared to other races. Extensive data on the prenatal diagnosis and management of cesarean-related abnormal placentation have improved outcomes of affected women. Fewer data are available however for the improvement of outcomes of cesarean-related gynecological conditions. In this review, the authors address the challenges and opportunities to research, educate and change health effects associated with cesarean delivery for all women.

Topics: Cesarean Section; Female; Genital Diseases, Female; Healthcare Disparities; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Maternal Mortality; Obstetric Labor Complications; Pregnancy

PubMed: 32887190
DOI: 10.1515/jpm-2020-0305

Review

Authors: Montserrat Ceballos-Rivera, Yoana González-González, Alejandra Alonso-Calvete...

OBJECTIVE

Caesarean section is a surgical intervention that consists of the extraction of the fetus by abdominal route through the incision in the uterus. Like any surgical intervention, caesarean section is not exempt from complications and these can be classified as short-term (acute pain) and long-term (adhesions in the scar, lumbar and pelvic pain, intestinal obstruction and ectopic pregnancies). Physiotherapy has different tools to address these complications. The aim of this study was to review the scientific bibliography to know the effects of physiotherapy on patients who have given birth by cesarean section.

METHODS

A search for articles was carried out during the month of December 2021 in the databases: PubMed, Medline, Cinahl, Scopus, PEDro and WOS using the search terms Cesarean Section, Physical Therapy Modalities and Physical therapy. As an inclusion criterion, it was established that the type of study was a Randomized Clinical Trial (RCT).

RESULTS

A total of 280 articles were obtained, of which 9 were selected after applying the eligibility criteria. In them, the most used physiotherapy intervention was electrotherapy, followed by massage therapy and therapeutic exercise. Studies show effects of these forms of physiotherapy, with a determined duration and frequency, with improvements in pain, activities of daily living, comfort level, joint ranges and reduction in the consumption of analgesics.

CONCLUSIONS

Physiotherapy has various modalities with which to attend complications after cesarean section, both in an immediate and a late phase, especially highlighting the reduction of pain.

Topics: Pregnancy; Female; Humans; Spain; Cesarean Section; Physical Therapy Modalities; Exercise Therapy; Pain; Randomized Controlled Trials as Topic

PubMed: 36636805
DOI: No ID Found

Review

Authors: Tina Lavender, G Justus Hofmeyr, James P Neilson...

BACKGROUND

Caesarean section rates are progressively rising in many parts of the world. One suggested reason is increasing requests by women for caesarean section in the absence of clear medical indications, such as placenta praevia, HIV infection, contracted pelvis and, arguably, breech presentation or previous caesarean section. The reported benefits of planned caesarean section include greater safety for the baby, less pelvic floor trauma for the mother, avoidance of labour pain and convenience. The potential disadvantages, from observational studies, include increased risk of major morbidity or mortality for the mother, adverse psychological sequelae, and problems in subsequent pregnancies, including uterine scar rupture and a greater risk of stillbirth and neonatal morbidity. The differences in neonatal physiology following vaginal and caesarean births are thought to have implications for the infant, with caesarean section potentially increasing the risk of compromised health in both the short and the long term. An unbiased assessment of advantages and disadvantages would assist discussion of what has become a contentious issue in modern obstetrics.

OBJECTIVES

To assess, from randomised trials, the effects on perinatal and maternal morbidity and mortality, and on maternal psychological morbidity, of planned caesarean delivery versus planned vaginal birth in women with no clear clinical indication for caesarean section.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2012) and reference lists of relevant studies.

SELECTION CRITERIA

All comparisons of intention to perform caesarean section and intention for women to give birth vaginally; random allocation to treatment and control groups; adequate allocation concealment; women at term with single fetuses with cephalic presentations and no clear medical indication for caesarean section.

DATA COLLECTION AND ANALYSIS

We identified no studies that met the inclusion criteria.

MAIN RESULTS

There were no included trials.

AUTHORS' CONCLUSIONS

There is no evidence from randomised controlled trials, upon which to base any practice recommendations regarding planned caesarean section for non-medical reasons at term. In the absence of trial data, there is an urgent need for a systematic review of observational studies and a synthesis of qualitative data to better assess the short- and long-term effects of caesarean section and vaginal birth.

Topics: Cesarean Section; Female; Humans; Pregnancy; Term Birth

PubMed: 22419296
DOI: 10.1002/14651858.CD004660.pub3

Authors: Shanta Sharma, Indra Dhakal

INTRODUCTION

According to the WHO, 15% of deliveries have precise indication for cesarean section where it is mandatory for the preservation of maternal and/or fetal health. Increasing rates of Lower Segment Caesarean Sections puts foreword various question that, whether a LSCS need to be reflected as a normal delivery in this twenty first century. There are conflicting reports regarding the safety of caesarean sections. While a significant number of cesarean delivery are performed for obstetrical indications, some are simply due to maternal request and may incur several risks for the child. Not much study has compared the complications of caesarean section with those of vaginal birth. Objective of this study is to find out and compare the common complications of cesarean section with vaginal deliveries on mothers.

METHODS

A descriptive study was conducted in two selected hospitals of Rupandehi district, Nepal. Data was collected as per pretested structured proforma from 550 respondents randomly and analyzed by using SPSS, MANOVA and Chi-square test to determine associations between categorical variables.

RESULTS

In total of 550 mothers, 408 (74.2%) had vaginal delivery and 142 (25.8%) had cesarean delivery.The common maternal complications were postpartum hemorrhage 116 (21.1%), prolonged labor 47 (8.5%) and wound infection 42 (7.6%).

CONCLUSIONS

The result of the study shows that the maternal complications were higher among LSCS compared to vaginal delivery.

Topics: Adult; Cesarean Section; Delivery, Obstetric; Female; Humans; Natural Childbirth; Nepal; Obstetric Labor Complications; Postpartum Hemorrhage; Pregnancy; Pregnancy Outcome

PubMed: 30058639
DOI: No ID Found

Review

Authors: Ties Boerma, Carine Ronsmans, Dessalegn Y Melesse...

In this Series paper, we describe the frequency of, trends in, determinants of, and inequalities in caesarean section (CS) use, globally, regionally, and in selected countries. On the basis of data from 169 countries that include 98·4% of the world's births, we estimate that 29·7 million (21·1%, 95% uncertainty interval 19·9-22·4) births occurred through CS in 2015, which was almost double the number of births by this method in 2000 (16·0 million [12·1%, 10·9-13·3] births). CS use in 2015 was up to ten times more frequent in the Latin America and Caribbean region, where it was used in 44·3% (41·3-47·4) of births, than in the west and central Africa region, where it was used in 4·1% (3·6-4·6) of births. The global and regional increases in CS use were driven both by an increasing proportion of births occurring in health facilities (accounting for 66·5% of the global increase) and increases in CS use within health facilities (33·5%), with considerable variation between regions. Based on the most recent data available for each country, 15% of births in 106 (63%) of 169 countries were by CS, whereas 47 (28%) countries showed CS use in less than 10% of births. National CS use varied from 0·6% in South Sudan to 58·1% in the Dominican Republic. Within-country disparities in CS use were also very large: CS use was almost five times more frequent in births in the richest versus the poorest quintiles in low-income and middle-income countries; markedly high CS use was observed among low obstetric risk births, especially among more educated women in, for example, Brazil and China; and CS use was 1·6 times more frequent in private facilities than in public facilities.

Topics: Cesarean Section; Female; Global Health; Health Equity; Humans; Maternal Health Services; Poverty; Pregnancy; Socioeconomic Factors

PubMed: 30322584
DOI: 10.1016/S0140-6736(18)31928-7

Authors: Marie-Andrée Grisbrook, Deborah Dewey, Colleen Cuthbert...

Caesarean section (C-section) deliveries account for nearly 30% of births annually with emergency C-sections accounting for 7-9% of all births. Studies have linked C-sections to postpartum depression (PPD). PPD is linked to reduced quality of parent-child interaction, and adverse effects on maternal and child health. New mothers' perceptions of more negative childbirth experiences, such as unplanned/emergency C-sections, are linked to post-traumatic stress disorder (PTSD), which in turn is related to PPD. Our objectives were to determine: (1) the association between C-section type (unplanned/emergency vs. planned) and PPD symptoms, and (2) if postnatal PTSD symptoms mediate this association. Employing secondary analysis of prospectively collected data from 354 mother-child dyads between 2009 and 2013 from the Alberta Pregnancy Outcomes and Nutrition (APrON) study, conditional process modeling was employed. The Edinburgh Postnatal Depression Scale (EPDS) and the Psychiatric Diagnostic Screening Questionnaire (PDSQ) were administered at three months postpartum, to assess for postpartum depressive and post-traumatic stress symptoms. The direct effect of emergency C-section on PPD symptoms was non-significant in adjusted and non-adjusted models; however, the indirect effect of emergency C-section on PPD symptoms with PTSD symptoms as a mediator was significant after controlling for prenatal depression symptoms, social support, and SES (β = 0.17 ( = 0.11), 95% CI [0.03, 0.42]). This suggests that mothers who experienced an emergency or unplanned C-section had increased PTSD scores of nearly half a point (0.47) compared to mothers who underwent a planned C-section, even after adjustment. Overall, emergency C-section was indirectly associated with PPD symptoms, through PTSD symptoms. Findings suggest that PTSD symptoms may be a mechanism through which emergency C-sections are associated with the development of PPD symptoms.

Topics: Cesarean Section; Depression; Depression, Postpartum; Female; Humans; Mothers; Parturition; Postpartum Period; Pregnancy; Stress Disorders, Post-Traumatic

PubMed: 35457767
DOI: 10.3390/ijerph19084900

Review

Authors: Jeni Stevens, Virginia Schmied, Elaine Burns...

The World Health Organization and the United Nations International Children's Emergency Fund recommends that mothers and newborns have skin-to-skin contact immediately after a vaginal birth, and as soon as the mother is alert and responsive after a Caesarean section. Skin-to-skin contact can be defined as placing a naked infant onto the bare chest of the mother. Caesarean birth is known to reduce initiation of breastfeeding, increase the length of time before the first breastfeed, reduce the incidence of exclusive breastfeeding, significantly delay the onset of lactation and increase the likelihood of supplementation. The aim of this review is to evaluate evidence on the facilitation of immediate (within minutes) or early (within 1 h) skin-to-skin contact following Caesarean section for healthy mothers and their healthy term newborns, and identify facilitators, barriers and associated maternal and newborn outcomes. A range of electronic databases were searched for papers reporting research findings published in English between January 2003 and October 2013. Seven papers met the criteria. This review has provided some evidence that with appropriate collaboration skin-to-skin contact during Caesarean surgery can be implemented. Further evidence was provided, albeit limited, that immediate or early skin-to-skin contact after a Caesarean section may increase breastfeeding initiation, decrease time to the first breastfeed, reduce formula supplementation in hospital, increase bonding and maternal satisfaction, maintain the temperature of newborns and reduce newborn stress.

Topics: Breast Feeding; Cesarean Section; Female; Humans; Infant, Newborn; Mother-Child Relations; Object Attachment; Pregnancy; Randomized Controlled Trials as Topic

PubMed: 24720501
DOI: 10.1111/mcn.12128

Authors: A P Betran, M R Torloni, J J Zhang...

Topics: Cesarean Section; Consensus Development Conferences as Topic; Female; Global Health; Humans; Pregnancy; World Health Organization

PubMed: 26681211
DOI: 10.1111/1471-0528.13526

Observational Study

Authors: Hana Hakim, Mohamed Derbel, Hajer Mtibaa...

INTRODUCTION

Vaginal delivery after caesarean section (VBAC) is recommended, but the rising rate of uterine rupture calls into question the safety of this practice.

AIM

To identify risk factors for uterine dehiscence and rupture.

METHODS

This was a prospective, analytical and descriptive observational study, carried out in a tertiary care maternity. We included all parturients with one previous caesarean section undergoing trial of labor. We assessed the quality of the uterine scar which was evaluated after delivery.

RESULTS

We included 300 patients with one previous caesarean section undergoing trial of labor. The trial of labor was successful (vaginal delivery) in 50.7% of cases. The uterine scar, assessed after delivery, was of good quality in 79% of cases. We noted 7 cases of uterine rupture, i.e. 2.3% of cases, and dehiscence in 56 patients, i.e. 18.6% of cases. Parity, conditions of previous caesarean section (programmed or emergency) and interpregnancy interval were significantly related to the labor outcome (p=0.004, p=0.001 and p=0.135 respectively). The occurrence of rupture or dehiscence was not significantly related to macrosomia, defined as a neonatal weight greater than 4000g (p=0.135).

CONCLUSION

Knowing the risk factors for uterine dehiscence and rupture would enable the obstetrician to properly assess the situation in order to make the correct decision and avoid neonatal and maternal complications.

Topics: Humans; Female; Uterine Rupture; Risk Factors; Pregnancy; Vaginal Birth after Cesarean; Adult; Prospective Studies; Surgical Wound Dehiscence; Trial of Labor; Young Adult; Cesarean Section; Parity

PubMed: 39441166
DOI: 10.62438/tunismed.v102i10.5015

Authors: F Plaat, S E R Stanford, D N Lucas...

A woman who experiences pain during caesarean section under neuraxial anaesthesia is at risk of adverse psychological sequelae. Litigation arising from pain during caesarean section under neuraxial anaesthesia has replaced accidental awareness under general anaesthesia as the most common successful medicolegal claim against obstetric anaesthetists. Generic guidelines on caesarean section exist, but they do not provide specific recommendations for this area of anaesthetic practice. This guidance aims to offer pragmatic advice to support anaesthetists in caring for women during caesarean section. It emphasises the importance of non-technical skills, offers advice on best practice and aims to encourage standardisation. The guidance results from a collaborative effort by anaesthetists, psychologists and patients and has been developed to support clinicians and promote standardisation of practice in this area.

Topics: Anesthesia, General; Anesthesia, Obstetrical; Anesthesiology; Cesarean Section; Female; Humans; Pain; Pregnancy

PubMed: 35325933
DOI: 10.1111/anae.15717