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Original Article
Cesarean-section Rates in Brazil from 2014 to 2016: Cross-sectional Analysis Using the Robson Classification
- Roxana Knobel
, - Thiago Jose Pinheiro Lopes ,
- Mariane de Oliveira Menezes ,
- Carla Betina Andreucci ,
- Juliana Toledo Gieburowski , [ ... ],
- Maira Libertad Soligo Takemoto
10-23-2020
Summary
Original ArticleCesarean-section Rates in Brazil from 2014 to 2016: Cross-sectional Analysis Using the Robson Classification
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(9):522-528
10-23-2020- Roxana Knobel ,
- Thiago Jose Pinheiro Lopes ,
- Mariane de Oliveira Menezes ,
- Carla Betina Andreucci ,
- Juliana Toledo Gieburowski ,
- Maira Libertad Soligo Takemoto
Views186Abstract
Objective
To obtain cesarean-section (CS) rates according to the Robson Group Classification in five different regions of Brazil.
Methods
A descriptive epidemiological study using data from secondary birth records fromthe Computer Science Department of the Brazilian Unified Health System (Datasus, in Portuguese) between January 1st, 2014, and December 31st, 2016, including all live births in Brazil.
Results
The overall rate of CSwas of 56%. The sample was divided into 11 groups, and vaginal births were more frequent in groups 1 (53.6%), 3 (80.0%) and 4 (55.1%). The highest CS rates were found in groups 5 (85.7%), 6 (89.5%), 7 (85.2%) and 9 (97.0%). The overall CS rate per region varied from 46.2% in the North to 62.1% in the Midwest. Group 5 was the largest obstetric population in the South, Southeast and Midwest, and group 3 was the largest in the North and Northeast. Group 5 contributed the most to the overall CS rate, accounting for 30.8% of CSs.
Conclusion
Over half of the births in Brazil were cesarean sections. The Midwest had the highestCS rates,while theNorth had the lowest. The largestobstetric population in the North and in the Northeast was composed of women in group 3, while in the South, Southeast and Midwest it was group 5. Among all regions, the largest contribution to the overall CS rate was from group 5.
Key-words Cesarean sectioninduced laborobstetric deliveryrepeat cesarean sectionvaginal birth after cesarean sectionSee moreViews186
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleCesarean-section Rates in Brazil from 2014 to 2016: Cross-sectional Analysis Using the Robson Classification
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(9):522-528
10-23-2020- Roxana Knobel ,
- Thiago Jose Pinheiro Lopes ,
- Mariane de Oliveira Menezes ,
- Carla Betina Andreucci ,
- Juliana Toledo Gieburowski ,
- Maira Libertad Soligo Takemoto
Views186Abstract
Objective
To obtain cesarean-section (CS) rates according to the Robson Group Classification in five different regions of Brazil.
Methods
A descriptive epidemiological study using data from secondary birth records fromthe Computer Science Department of the Brazilian Unified Health System (Datasus, in Portuguese) between January 1st, 2014, and December 31st, 2016, including all live births in Brazil.
Results
The overall rate of CSwas of 56%. The sample was divided into 11 groups, and vaginal births were more frequent in groups 1 (53.6%), 3 (80.0%) and 4 (55.1%). The highest CS rates were found in groups 5 (85.7%), 6 (89.5%), 7 (85.2%) and 9 (97.0%). The overall CS rate per region varied from 46.2% in the North to 62.1% in the Midwest. Group 5 was the largest obstetric population in the South, Southeast and Midwest, and group 3 was the largest in the North and Northeast. Group 5 contributed the most to the overall CS rate, accounting for 30.8% of CSs.
Conclusion
Over half of the births in Brazil were cesarean sections. The Midwest had the highestCS rates,while theNorth had the lowest. The largestobstetric population in the North and in the Northeast was composed of women in group 3, while in the South, Southeast and Midwest it was group 5. Among all regions, the largest contribution to the overall CS rate was from group 5.
Key-words Cesarean sectioninduced laborobstetric deliveryrepeat cesarean sectionvaginal birth after cesarean sectionSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Roxana Knobel
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Original Article
Improving the Management of High-Risk Pregnancies with the Use of the Robson Classification
- Mario Dias Correa Junior ,
- Bárbara Moreira Ribeiro Trindade dos Santos ,
- José Reinaldo Correa Roveda ,
- Laura Carolina Menezes Vieira Silva ,
- Larissa Silva Guimarães , [ ... ],
- Samuel Cristóvão Lopes Gonçalves
09-25-2020
Summary
Original ArticleImproving the Management of High-Risk Pregnancies with the Use of the Robson Classification
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(8):448-453
09-25-2020- Mario Dias Correa Junior ,
- Bárbara Moreira Ribeiro Trindade dos Santos ,
- José Reinaldo Correa Roveda ,
- Laura Carolina Menezes Vieira Silva ,
- Larissa Silva Guimarães ,
- Samuel Cristóvão Lopes Gonçalves
Views174Abstract
Objective
To analyze the rates of cesarean delivery longitudinally in a university hospital using the Robson classification.
Methods
Data related to births performed between 2014 and 2018 and recorded in the Maternal and Neonatal Health Information System (Sistema de Informações em Saúde Materna e Neonatal, SISMATER, in Portuguese) were analyzed using the Robson classification. As an aid, we used articles published in the last five years that approach the same topic in other Brazilian maternity hospitals; they were retrieved from the LILACS, MEDLINE, CINAHL, Scopus, Web of Science and Cochrane Library databases.
Results
There was little variation in the total rate of cesarean sections in the period; however, the profile of each group changed over the years. It was possible to verify a significant reduction in the participation of groups of pregnant women with lower risk and an increase in high-risk pregnancies, attributable to the decrease in beds in the institution, with a greater transfer of patients. In addition, there was a reduction in cesarean sections among the lower-risk groups,while the rate among the higher-risk groups remained stable.
Conclusion
The use of the Robson classification to stratify cesarean deliveries contributes to a better analysis of the indications for cesarean delivery, enabling the establishment of strategies to reduce the rates, generating a positive impact on hospital management and quality of care.
Key-words birthing centersCesarean sectionevidence-based clinical practicehospitalmanagementmaternityrobson classificationSee moreViews174This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleImproving the Management of High-Risk Pregnancies with the Use of the Robson Classification
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(8):448-453
09-25-2020- Mario Dias Correa Junior ,
- Bárbara Moreira Ribeiro Trindade dos Santos ,
- José Reinaldo Correa Roveda ,
- Laura Carolina Menezes Vieira Silva ,
- Larissa Silva Guimarães ,
- Samuel Cristóvão Lopes Gonçalves
Views174Abstract
Objective
To analyze the rates of cesarean delivery longitudinally in a university hospital using the Robson classification.
Methods
Data related to births performed between 2014 and 2018 and recorded in the Maternal and Neonatal Health Information System (Sistema de Informações em Saúde Materna e Neonatal, SISMATER, in Portuguese) were analyzed using the Robson classification. As an aid, we used articles published in the last five years that approach the same topic in other Brazilian maternity hospitals; they were retrieved from the LILACS, MEDLINE, CINAHL, Scopus, Web of Science and Cochrane Library databases.
Results
There was little variation in the total rate of cesarean sections in the period; however, the profile of each group changed over the years. It was possible to verify a significant reduction in the participation of groups of pregnant women with lower risk and an increase in high-risk pregnancies, attributable to the decrease in beds in the institution, with a greater transfer of patients. In addition, there was a reduction in cesarean sections among the lower-risk groups,while the rate among the higher-risk groups remained stable.
Conclusion
The use of the Robson classification to stratify cesarean deliveries contributes to a better analysis of the indications for cesarean delivery, enabling the establishment of strategies to reduce the rates, generating a positive impact on hospital management and quality of care.
Key-words birthing centersCesarean sectionevidence-based clinical practicehospitalmanagementmaternityrobson classificationSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Mario Dias Correa Junior
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Original Article
Cesarean Section Rate Analysis in a Tertiary Hospital in Portugal According to Robson Ten Group Classification System
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(6):310-315
07-17-2020
Summary
Original ArticleCesarean Section Rate Analysis in a Tertiary Hospital in Portugal According to Robson Ten Group Classification System
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(6):310-315
07-17-2020Views132See moreAbstract
Objective
The Robson 10 group classification system (RTGCS) is a reproducible, clinically relevant and prospective classification system proposed by the World Health Organization (WHO) as a global standard for assessing, monitoring and comparing cesarean section (CS) rates. The purpose of the present study is to analyze CS rates according to the RTGCS over a 3-year period and to identify the main contributors to this rate.
Methods
We reviewed data regarding deliveries performed from 2014 up to 2016 in a tertiary hospital in Portugal, and classified all women according to the RTGCS. We analyzed the CS rate in each group.
Results
We included data from 6,369 deliveries. Groups 1 (n = 1,703), 2 (n = 1,229) and 3 (n = 1,382) represented 67.7% of the obstetric population. The global CS rate was 25% (n = 1,594). Groups 1, 2, 5 and 10 were responsible for 74.2% of global CS deliveries.
Conclusion
As expected, Groups 1, 2, 5 and 10 were the greatest contributors to the overall CS rate. An attempt to increase the number of vaginal deliveries in these groups, especially in Groups 2 and 5, might contribute to the reduction of the CS rate.
Views132This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleCesarean Section Rate Analysis in a Tertiary Hospital in Portugal According to Robson Ten Group Classification System
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(6):310-315
07-17-2020Views132See moreAbstract
Objective
The Robson 10 group classification system (RTGCS) is a reproducible, clinically relevant and prospective classification system proposed by the World Health Organization (WHO) as a global standard for assessing, monitoring and comparing cesarean section (CS) rates. The purpose of the present study is to analyze CS rates according to the RTGCS over a 3-year period and to identify the main contributors to this rate.
Methods
We reviewed data regarding deliveries performed from 2014 up to 2016 in a tertiary hospital in Portugal, and classified all women according to the RTGCS. We analyzed the CS rate in each group.
Results
We included data from 6,369 deliveries. Groups 1 (n = 1,703), 2 (n = 1,229) and 3 (n = 1,382) represented 67.7% of the obstetric population. The global CS rate was 25% (n = 1,594). Groups 1, 2, 5 and 10 were responsible for 74.2% of global CS deliveries.
Conclusion
As expected, Groups 1, 2, 5 and 10 were the greatest contributors to the overall CS rate. An attempt to increase the number of vaginal deliveries in these groups, especially in Groups 2 and 5, might contribute to the reduction of the CS rate.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Article
Pubic Arch Angle Measurement by Transperineal Ultrasonography: A Prospective Cross-Sectional Study
- Raimundo Homero Carvalho Neto ,
- Antonio Brazil Viana Junior ,
- Antonio Fernandes Moron ,
- Edward Araujo Júnior ,
- Francisco Herlânio Costa Carvalho , [ ... ],
- Helvécio Neves Feitosa
05-18-2020
Summary
Original ArticlePubic Arch Angle Measurement by Transperineal Ultrasonography: A Prospective Cross-Sectional Study
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(4):181-187
05-18-2020- Raimundo Homero Carvalho Neto ,
- Antonio Brazil Viana Junior ,
- Antonio Fernandes Moron ,
- Edward Araujo Júnior ,
- Francisco Herlânio Costa Carvalho ,
- Helvécio Neves Feitosa
Views159See moreAbstract
Objective
To evaluate the ability of the pubic arch angle (PAA) as measured by transperineal ultrasonography during labor to predict the delivery type and cephalic pole disengagement mode.
Methods
The present prospective cross-sectional study included 221 women in singleton-gestational labor ≥ 37 weeks with cephalic fetuses who underwent PAA measurement using transperineal ultrasonography. These measurements were correlated with the delivery type, cephalic pole disengagement mode, and fetal and maternal characteristics.
Results
Out of the subjects, 153 (69.2%) had spontaneous vaginal delivery, 7 (3.2%) gave birth by forceps, and 61 (27.6%) delivered by cesarean section. For the analysis, deliveries were divided into two groups: vaginal and surgical (forceps and cesarean). The mean PAA was 102 ± 7.5º (range, 79.3-117.7º). No statistically significant difference was observed in delivery type (102.6 ± 7.2º versus 100.8 ± 7.9º, p = 0.105). The occipitoanterior position was seen in 94.1% of the fetuses and the occipitoposterior position in 5.8%. A narrower PAA was found in the group of surgical deliveries (97.9 ± 9.6º versus 102.6 ± 7.3º, p = 0.049). Multivariate regression analysis showed that PAA was a predictive variable for the occurrence of head disengagement in occipital varieties after birth (odds ratio, 0.9; 95% confidence interval, 0.82-0.99; p = 0.026).
Conclusion
Ultrasonographic measurement of the PAA was not a predictor of delivery type, but was associated with the persistence of occipital varieties after birth.
Views159This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticlePubic Arch Angle Measurement by Transperineal Ultrasonography: A Prospective Cross-Sectional Study
Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(4):181-187
05-18-2020- Raimundo Homero Carvalho Neto ,
- Antonio Brazil Viana Junior ,
- Antonio Fernandes Moron ,
- Edward Araujo Júnior ,
- Francisco Herlânio Costa Carvalho ,
- Helvécio Neves Feitosa
Views159See moreAbstract
Objective
To evaluate the ability of the pubic arch angle (PAA) as measured by transperineal ultrasonography during labor to predict the delivery type and cephalic pole disengagement mode.
Methods
The present prospective cross-sectional study included 221 women in singleton-gestational labor ≥ 37 weeks with cephalic fetuses who underwent PAA measurement using transperineal ultrasonography. These measurements were correlated with the delivery type, cephalic pole disengagement mode, and fetal and maternal characteristics.
Results
Out of the subjects, 153 (69.2%) had spontaneous vaginal delivery, 7 (3.2%) gave birth by forceps, and 61 (27.6%) delivered by cesarean section. For the analysis, deliveries were divided into two groups: vaginal and surgical (forceps and cesarean). The mean PAA was 102 ± 7.5º (range, 79.3-117.7º). No statistically significant difference was observed in delivery type (102.6 ± 7.2º versus 100.8 ± 7.9º, p = 0.105). The occipitoanterior position was seen in 94.1% of the fetuses and the occipitoposterior position in 5.8%. A narrower PAA was found in the group of surgical deliveries (97.9 ± 9.6º versus 102.6 ± 7.3º, p = 0.049). Multivariate regression analysis showed that PAA was a predictive variable for the occurrence of head disengagement in occipital varieties after birth (odds ratio, 0.9; 95% confidence interval, 0.82-0.99; p = 0.026).
Conclusion
Ultrasonographic measurement of the PAA was not a predictor of delivery type, but was associated with the persistence of occipital varieties after birth.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Raimundo Homero Carvalho Neto
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Original Articles
Risks of Maternal Obesity in Pregnancy: A Case-control Study in a Portuguese Obstetrical Population
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(12):682-687
02-03-2019
Summary
Original ArticlesRisks of Maternal Obesity in Pregnancy: A Case-control Study in a Portuguese Obstetrical Population
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(12):682-687
02-03-2019Views160See moreAbstract
Objective
The present study aims to understand to what extent obesity is related to adversematernal, obstetrical, and neonatal outcomes in a Portuguese obstetrical population.
Methods
A retrospective case-control study was conducted at the Department of Obstetrics of a differentiated perinatal care facility. The study compared 1,183 obese pregnant womenwith 5,399 normal or underweight pregnantwomen for the occurrence of gestational diabetes, hypertensive pregnancy disorders, and preterm birth. Mode of delivery, birthweight, and neonatal intensive care unit (ICU) admissionswere also evaluated. Mean blood glucose values were evaluated and compared between groups, in the first and second trimesters of pregnancy. Only singleton pregnancies were considered.
Results
The prevalence of obesity was 13.6%. Obese pregnant women were significantly more likely to have cesarean sections (adjusted odds ratio [aOR] 2.0, p< 0.001), gestational diabetes (aOR 2.14, p< 0.001), hypertensive pregnancy disorders (aOR 3.43, p< 0.001), and large-for-gestational age ormacrosomic infants (aOR 2.13, p< 0.001), and less likely to have small-for-gestational age newborns (aOR 0.51, p< 0.009). No significant differences were found in terms of pretermbirths, fetal/neonatal deaths, low birthweight newborns, and neonatal ICU admissions among cases and controls. Maternal obesity was significantly associated with higher mean blood glucose levels, in the first and second trimesters of pregnancy.
Conclusion
Obesity is associated with increased risks of adverse pregnancy and neonatal outcomes. These risks seem to increase progressively with increasing body mass index (BMI) class. Female obesity should be considered a major public health issue and has consequences on maternal-fetal health.
Views160This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticlesRisks of Maternal Obesity in Pregnancy: A Case-control Study in a Portuguese Obstetrical Population
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(12):682-687
02-03-2019Views160See moreAbstract
Objective
The present study aims to understand to what extent obesity is related to adversematernal, obstetrical, and neonatal outcomes in a Portuguese obstetrical population.
Methods
A retrospective case-control study was conducted at the Department of Obstetrics of a differentiated perinatal care facility. The study compared 1,183 obese pregnant womenwith 5,399 normal or underweight pregnantwomen for the occurrence of gestational diabetes, hypertensive pregnancy disorders, and preterm birth. Mode of delivery, birthweight, and neonatal intensive care unit (ICU) admissionswere also evaluated. Mean blood glucose values were evaluated and compared between groups, in the first and second trimesters of pregnancy. Only singleton pregnancies were considered.
Results
The prevalence of obesity was 13.6%. Obese pregnant women were significantly more likely to have cesarean sections (adjusted odds ratio [aOR] 2.0, p< 0.001), gestational diabetes (aOR 2.14, p< 0.001), hypertensive pregnancy disorders (aOR 3.43, p< 0.001), and large-for-gestational age ormacrosomic infants (aOR 2.13, p< 0.001), and less likely to have small-for-gestational age newborns (aOR 0.51, p< 0.009). No significant differences were found in terms of pretermbirths, fetal/neonatal deaths, low birthweight newborns, and neonatal ICU admissions among cases and controls. Maternal obesity was significantly associated with higher mean blood glucose levels, in the first and second trimesters of pregnancy.
Conclusion
Obesity is associated with increased risks of adverse pregnancy and neonatal outcomes. These risks seem to increase progressively with increasing body mass index (BMI) class. Female obesity should be considered a major public health issue and has consequences on maternal-fetal health.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Original Articles
Intrauterine Device Insertion during Cesarean Section in Women without Prenatal Contraception Counseling: Lessons from a Country with High Cesarean Rates
- Alberto Moreno Zaconeta ,
- Ana Carolina Oliveira,
- Flavielly Souza Estrela,
- Thalia Maia Vasconcelos,
- Paulo Sergio França, [ ... ],
- Angelica Amorim Amato
09-16-2019
Summary
Original ArticlesIntrauterine Device Insertion during Cesarean Section in Women without Prenatal Contraception Counseling: Lessons from a Country with High Cesarean Rates
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(8):485-492
09-16-2019- Alberto Moreno Zaconeta ,
- Ana Carolina Oliveira,
- Flavielly Souza Estrela,
- Thalia Maia Vasconcelos,
- Paulo Sergio França,
- Miriam da Silva Wanderley,
- Angelica Amorim Amato
Views83Abstract
Objective
Themoment of admission for deliverymay be inappropriate for offering an intrauterine device (IUD) to women without prenatal contraception counseling. However, in countries with high cesarean rates and deficient prenatal contraception counseling, this strategy may reduce unexpected pregnancies and repeated cesarean sections.
Methods
This was a prospective cohort study involving 100 women without prenatal contraception counseling. Postplacental IUD was offered after admission for delivery and placed during cesarean. The rates of IUD continuation, uterine perforation, and endometritis were assessed at 6 weeks and 6 months, and the proportion of women continuing with IUD at 6 months was assessed with respect to the number of previous cesareans.
Results
Ninety-seven women completed the follow-up. The rate of IUD continuation was 91% at 6 weeks and 83.5% at 6 months. The expulsion/removal rate in the first 6 weeks was not different from that between 6 weeks and 6 months (9 vs 9.1%, respectively). There were 2 cases of endometritis (2.1%), and no case of uterine perforation. Among 81 women continuing with intrauterine device after 6-months, 31% had undergone only the cesarean section in which the IUD was inserted, 44% had undergone 2 and 25% had undergone 3 or more cesarean sections.
Conclusion
Two thirds of the women who continued with IUD at 6 months had undergone 2 ormore cesarean sections. Since offering trial of labor is unusual after 2 or more previous cesareans, we believe that offering IUD after admission for delivery may reduce the risk of repeated cesarean sections and its inherent risks.
Key-words Cesarean sectionIntrauterine deviceintrauterine device continuationpostplacental intrauterine device insertionprenatal contraception counselingSee moreViews83This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticlesIntrauterine Device Insertion during Cesarean Section in Women without Prenatal Contraception Counseling: Lessons from a Country with High Cesarean Rates
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(8):485-492
09-16-2019- Alberto Moreno Zaconeta ,
- Ana Carolina Oliveira,
- Flavielly Souza Estrela,
- Thalia Maia Vasconcelos,
- Paulo Sergio França,
- Miriam da Silva Wanderley,
- Angelica Amorim Amato
Views83Abstract
Objective
Themoment of admission for deliverymay be inappropriate for offering an intrauterine device (IUD) to women without prenatal contraception counseling. However, in countries with high cesarean rates and deficient prenatal contraception counseling, this strategy may reduce unexpected pregnancies and repeated cesarean sections.
Methods
This was a prospective cohort study involving 100 women without prenatal contraception counseling. Postplacental IUD was offered after admission for delivery and placed during cesarean. The rates of IUD continuation, uterine perforation, and endometritis were assessed at 6 weeks and 6 months, and the proportion of women continuing with IUD at 6 months was assessed with respect to the number of previous cesareans.
Results
Ninety-seven women completed the follow-up. The rate of IUD continuation was 91% at 6 weeks and 83.5% at 6 months. The expulsion/removal rate in the first 6 weeks was not different from that between 6 weeks and 6 months (9 vs 9.1%, respectively). There were 2 cases of endometritis (2.1%), and no case of uterine perforation. Among 81 women continuing with intrauterine device after 6-months, 31% had undergone only the cesarean section in which the IUD was inserted, 44% had undergone 2 and 25% had undergone 3 or more cesarean sections.
Conclusion
Two thirds of the women who continued with IUD at 6 months had undergone 2 ormore cesarean sections. Since offering trial of labor is unusual after 2 or more previous cesareans, we believe that offering IUD after admission for delivery may reduce the risk of repeated cesarean sections and its inherent risks.
Key-words Cesarean sectionIntrauterine deviceintrauterine device continuationpostplacental intrauterine device insertionprenatal contraception counselingSee moreThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. - Alberto Moreno Zaconeta
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Original Article
Factors Associated with Intrapartum Cesarean Section in Women Submitted to Labor Induction
- Glaucia Regina Pfützenreuter,
- Juliana Coutinho Cavalieri,
- Ana Paula de Oliveira Fragoso,
- Karine Souza Da Corregio,
- Paulo Fontoura Freitas, [ ... ],
- Alberto Trapani Júnior
07-22-2019
Summary
Original ArticleFactors Associated with Intrapartum Cesarean Section in Women Submitted to Labor Induction
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(6):363-370
07-22-2019- Glaucia Regina Pfützenreuter,
- Juliana Coutinho Cavalieri,
- Ana Paula de Oliveira Fragoso,
- Karine Souza Da Corregio,
- Paulo Fontoura Freitas,
- Alberto Trapani Júnior
Views152See moreAbstract
Objective
To evaluate the results of induced labor and to determine the main factors associated with intrapartum cesarean section after patients being submitted to this procedure at the Hospital Universitário of the Universidade Federal de Santa Catarina (HU/UFSC, in the Portuguese acronym), Florianópolis, state of Santa Catarina, Brazil.
Methods
A retrospective cross-sectional study that included all the pregnancies that resulted in single-fetus births, whose gestational-age was > 22 weeks and that had been submitted to labor induction at the HU/UFSC in the period from 2013 to 2016.
Results
During the proposed period, 1,491 pregnant women were submitted to the labor induction protocol. In 1,264 cases (84.8%), induction resulted in labor, with 830 (65.7%) progressing to vaginal delivery. Gestational age ≥ 41 + 0 weekswas themost common indication for induced labor (55.2%), and vaginal administration of misoprostol was themost commonly usedmethod (72.0%). Among these pregnant women, the cesarean section rate was of 34.3%. Considering the cases of induction failure, the cesarean section rate rose to 44.3%. The factors associated with cesarean section were: previous history of cesarean delivery (PR [prevalence ratio] = 1.48; 95%CI [confidence interval]: 1.51-1.88), fetuses with intrauterine growth restriction (IUGR) (PR = 1.82; 95%CI: 1.32-2.19), Bishop score ≤ 6 (PR = 1.33; 95%CI: 1.01-1.82), and induction time either < 12 hours (PR = 1.44; 95%CI: 1.17-1.66) or > 36 hours (PR = 1.51; 95% CI 1.22-1.92) between the beginning of the induction and the birth.
Conclusion
Labor induction was successful inmost patients. In the cases in which the final outcome was a cesarean section, the most strongly associated factors were: previous history of cesarean delivery, presence of fetuses with IUGR, and either excessively short or excessively long periods of induction.
Views152This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Original ArticleFactors Associated with Intrapartum Cesarean Section in Women Submitted to Labor Induction
Revista Brasileira de Ginecologia e Obstetrícia. 2019;41(6):363-370
07-22-2019- Glaucia Regina Pfützenreuter,
- Juliana Coutinho Cavalieri,
- Ana Paula de Oliveira Fragoso,
- Karine Souza Da Corregio,
- Paulo Fontoura Freitas,
- Alberto Trapani Júnior
Views152See moreAbstract
Objective
To evaluate the results of induced labor and to determine the main factors associated with intrapartum cesarean section after patients being submitted to this procedure at the Hospital Universitário of the Universidade Federal de Santa Catarina (HU/UFSC, in the Portuguese acronym), Florianópolis, state of Santa Catarina, Brazil.
Methods
A retrospective cross-sectional study that included all the pregnancies that resulted in single-fetus births, whose gestational-age was > 22 weeks and that had been submitted to labor induction at the HU/UFSC in the period from 2013 to 2016.
Results
During the proposed period, 1,491 pregnant women were submitted to the labor induction protocol. In 1,264 cases (84.8%), induction resulted in labor, with 830 (65.7%) progressing to vaginal delivery. Gestational age ≥ 41 + 0 weekswas themost common indication for induced labor (55.2%), and vaginal administration of misoprostol was themost commonly usedmethod (72.0%). Among these pregnant women, the cesarean section rate was of 34.3%. Considering the cases of induction failure, the cesarean section rate rose to 44.3%. The factors associated with cesarean section were: previous history of cesarean delivery (PR [prevalence ratio] = 1.48; 95%CI [confidence interval]: 1.51-1.88), fetuses with intrauterine growth restriction (IUGR) (PR = 1.82; 95%CI: 1.32-2.19), Bishop score ≤ 6 (PR = 1.33; 95%CI: 1.01-1.82), and induction time either < 12 hours (PR = 1.44; 95%CI: 1.17-1.66) or > 36 hours (PR = 1.51; 95% CI 1.22-1.92) between the beginning of the induction and the birth.
Conclusion
Labor induction was successful inmost patients. In the cases in which the final outcome was a cesarean section, the most strongly associated factors were: previous history of cesarean delivery, presence of fetuses with IUGR, and either excessively short or excessively long periods of induction.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. -
Case Reports
Vesicouterine Fistula (Youssef Syndrome): Case Report and Literature Review
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(9):563-569
09-01-2018
Summary
Case ReportsVesicouterine Fistula (Youssef Syndrome): Case Report and Literature Review
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(9):563-569
09-01-2018Views118See moreAbstract
Objective
To describe a case of vesicouterine fistula and to review the literature related to this condition.
Methods
For the review, we accessed the MEDLINE, BIREME and LILACS databases; the references of the searched articles were also reviewed.
Results
A 38-year-old woman, in the 1st day after her 3rd cesarean, presented heavy hematuria, which was considered secondary to a difficult dissection of the bladder. A total of 6 months after delivery, she failed to resume her regular menstrual cycles and presented cyclic menouria and amenorrhea. At this time, she had two episodes of urethral obstruction by blood clots. She remained without a correct diagnosis until about two years postdelivery, when a vesicouterine fistula was confirmed through cystoscopy. A surgical correction through open abdominal route, coupled with hysterectomy, was performed. After the surgery, the symptoms disappeared. The review showed a tendency of change in the relative frequency of the different types of genitourinary fistulae. Vesicovaginal fistulae, usually caused by inadequate care during labor, are becoming less frequent than those secondary tomedical procedures, such as vesicouterine fistulae. The most common cause of this latter kind of fistula is cesarean section, especially repeated cesarean sections. The diagnosis is confirmed through one or more imaging exams, or through cystoscopy. The most common treatment is surgical, and the routes are: open abdominal, laparoscopic, vaginal or robotic. There are some reports of success with the conservative treatment.
Conclusion
Vesicouterine fistulae are becoming more common because of the increase in the performance of cesarean sections, and the condition must be considered a possible complication thereof.
Views118This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Summary
Case ReportsVesicouterine Fistula (Youssef Syndrome): Case Report and Literature Review
Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(9):563-569
09-01-2018Views118See moreAbstract
Objective
To describe a case of vesicouterine fistula and to review the literature related to this condition.
Methods
For the review, we accessed the MEDLINE, BIREME and LILACS databases; the references of the searched articles were also reviewed.
Results
A 38-year-old woman, in the 1st day after her 3rd cesarean, presented heavy hematuria, which was considered secondary to a difficult dissection of the bladder. A total of 6 months after delivery, she failed to resume her regular menstrual cycles and presented cyclic menouria and amenorrhea. At this time, she had two episodes of urethral obstruction by blood clots. She remained without a correct diagnosis until about two years postdelivery, when a vesicouterine fistula was confirmed through cystoscopy. A surgical correction through open abdominal route, coupled with hysterectomy, was performed. After the surgery, the symptoms disappeared. The review showed a tendency of change in the relative frequency of the different types of genitourinary fistulae. Vesicovaginal fistulae, usually caused by inadequate care during labor, are becoming less frequent than those secondary tomedical procedures, such as vesicouterine fistulae. The most common cause of this latter kind of fistula is cesarean section, especially repeated cesarean sections. The diagnosis is confirmed through one or more imaging exams, or through cystoscopy. The most common treatment is surgical, and the routes are: open abdominal, laparoscopic, vaginal or robotic. There are some reports of success with the conservative treatment.
Conclusion
Vesicouterine fistulae are becoming more common because of the increase in the performance of cesarean sections, and the condition must be considered a possible complication thereof.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 
Cesarean section Archives - Page 6 of 8 - Revista Brasileira de Ginecologia e Obstetrícia
