Introduction: Cesarean section is a surgical intervention which consists in the extraction of a fetus from the uterus after its incision. The rate of cesarean section varies depending on the country and the health fac...Introduction: Cesarean section is a surgical intervention which consists in the extraction of a fetus from the uterus after its incision. The rate of cesarean section varies depending on the country and the health facility. For this reason, in 2015, the World Health Organization (WHO) recommended the use of Robson’s classification to evaluate the practice of cesarean sections in order to identify the groups of women who had abnormally high rates. The objective of our study was to evaluate cesarean sections using the Robson’s classification in CHRACERH and in the Yaoundé Central Hospital (YCH). Methodology: We carried out a retrospective cross sectional and descriptive study in two (02) university hospitals in Yaoundé which took place from December 2017 to May 2018. We included in our study all women who gave birth over a period of two (02) years from January 2016 to December 2017 in these two health facilities. Our sampling was exhaustive over the study period. The parturients’ information was collected using an anonymous and pretested questionnaire. The Robson’s group of every parturient was determined. Descriptive parameters like mean and proportions were calculated. We compared the rates and indications of cesarean sections between the both hospitals using Chi<sup>2</sup> test. Results: Out of 330 deliveries realized in CHRACERH, we had 90 cesarean sections;hence, a rate of 27.2%. Out of 1863 deliveries carried out at the YCH, 462 were by cesarean section, hence a rate of 24.8%. The women who belonged to groups 1, 3 and 5 contributed to the highest rates of cesarean sections in both hospitals: in CHRACERH, group 5 (31.1%), group 3 (20%) and group 1 (15.6%), at YCH: group 3 (22.5%), group 1 (21.6%) and group 5 (17.3%). The indications of the cesarean sections varied depending on the Robson’s group and the hospital, the principal indication in group 1 was acute fetal distress (28.6%) in CHRACERH and cephalopelvic disproportion (36.7%) at YCH. Cephalopelvic disproportion was the predominant indication in groups 3 of CHRACERH (44.4%) and YCH (39.2%). In groups 5, CHRACERH and of YCH, a scarred uterus was the principal indication for the cesarean section at 82.4% and 78.4% respectively. At CHRACERH, the maternofetal complications were more frequent in groups 1 and 2 at the YCH, this was the case mostly in groups 1 and 3. Conclusion: The Robson’s classification is an adequate tool for the evaluation and comparison of the rates of cesarean sections. The rates of cesarean section in CHRACERH (27.2%) and at YCH (24.8%) were higher than the rates recommended by WHO. Robson’s groups 1, 3 and 5 were identified as the groups most at risk for cesarean sections in the both hospitals.展开更多
<strong>Background:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Quality assurance in labor and delivery is needed. The method...<strong>Background:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Quality assurance in labor and delivery is needed. The method must be simple and consistent, and be of universal value. The 10-Group Classification System is a simple method providing a common starting point for further detailed analysis within which all perinatal events and outcomes can be measured and compared. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> The purpose of this study was to analyze cesarean section (CS) rates using the classification system of Robson’s ten groups and to identify the main contributors to the overall CS rate in Burkina Faso’s regional and university hospitals. </span><b><span style="font-family:Verdana;">Materials and Method:</span></b><span style="font-family:Verdana;"> A cross-sectional study with retrospective collection was carried out. All women who gave birth between July 1, 2017 and June 30, 2018, in the Regional Hospital Centres (RHC) and University Hospital Centres (UHC) of Burkina Faso were classified according to the Robson ten-group method. The overall CS rates and in each Robson group were calculated, as well as the contribution of each group to the overall CS rate. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The CS rate was 26.5% (8543 out of 32,240 deliveries) during the study period. nulliparous women with single term pregnancy in cephalic presentation during spontaneous labour (group 1), multiparous women with single pregnancy in cephalic presentation, gestational age ≥37SA, spontaneous labour (group 3) and multiparous women with previous CS (group 5) were the main contributors (67.7%) to the overall CS rate. In addition, we observed a variation in CS rates between different hospitals, especially among women with full-term pregnancies in cephalic presentation without previous CS (groups 1 to 4), showing large differences in emergency obstetric and neonatal care across the country. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Women in groups 1, 3 and 5 were the most important contributors to the overall CS rate in Burkina Faso. It appears that efforts to reduce the overall rate of CS should focus on vaginal delivery on the scarred uterus, reduction of CS rates in nulliparous women with full-term pregnancy in cephalic presentation (groups 1) and proper monitoring of multiparous women with full-term pregnancy in spontaneous labour (group 3).</span></span>展开更多
<strong>Introduction:</strong> <span><span><span style="font-family:""><span style="font-family:Verdana;">Caesarean section (CS) is a major reproductive hea...<strong>Introduction:</strong> <span><span><span style="font-family:""><span style="font-family:Verdana;">Caesarean section (CS) is a major reproductive health intervention to improve maternal and foetal outcomes if appropriately performed. </span><span style="font-family:Verdana;">This study aimed to assess the quality of Caesarean sections (CS) in a rural</span> <span><span style="font-family:Verdana;">setting in Cameroon. </span><b><span style="font-family:Verdana;">Materials and Methods: </span></b><span style="font-family:Verdana;">A prospective study con</span></span><span style="font-family:Verdana;">ducted in 3 hospitals from February 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> 2020 to April 30</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> 2020. One hundred and twenty women who had a CS were included. Data were grouped into 5 categories: </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">1</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) Sociodemographic and obstetrical characteristics, </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">2</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) Geographic and financial access, </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">3</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) Diagnostic procedures, </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">4</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) Operative parameters and </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">5</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) Post-operative parameters. The Dujardin’s model and context-relevant</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> criteria served to construct the quality score. The scale was 0 </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> 20 and scores ≤ 15 were considered as unacceptable quality while those >15 were considered as acceptable quality CS. Logistic regressions permitted to measure associations. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> There were 538 deliveries and 120 (22.3%) CS. The mean (SD) gestational age was 38.7 (2.6) weeks with extremes of 31 and 43 weeks. Group 5 of the Robson’s classification was predominant (35.0%). Motorbikes were the mode of transport to the maternity for 72.5% (87/120) of women. No referral was made by ambulance. Only 44 (36.7%) women had paid the full cost of the CS prior to surgery. In addition, 26 (21.6%) women had a complete clinical examination on admission. The surgical team was not complete (<6 staffs) in 56 (43.3%) cases. Anaesthesia was done by nurses in all cases. CS was done by a general practitioner and by nurses in 86 (71.7%) and 14 (11.7%) cases respectively. Overall, mean (SD) quality score (QS) was 16.33 (1.60).</span><b> </b><span style="font-family:Verdana;">Sixty six of the 120 (55.3%) caesarean sections had unacceptable quality CS. Mean (SD) QS was significantly higher in faith-based hospitals than in public hospitals (18.00 (0.91) versus 15.59 (1.24);P</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">0.001).</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Immediate </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">postoperative clinical monitoring was effective only in 66 (55%) of cases. Apgar score was below 7 over 10 in 17 (14.2%) cases of which 6 freshes still births. No maternal death was recorded and maternal complications were recorded in 14 (11.7%) cases. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">The quality of CS is generally poor in rural settings in West-Cameroon. The quantity and quality of staffs required for Caesarean sections in the hospitals are sometimes insufficient. The poor quality of CS in this region could be addressed using the faith-based hospitals: St Vincent de Paul’s Hospital as a model.</span></span></span></span>展开更多
文摘Introduction: Cesarean section is a surgical intervention which consists in the extraction of a fetus from the uterus after its incision. The rate of cesarean section varies depending on the country and the health facility. For this reason, in 2015, the World Health Organization (WHO) recommended the use of Robson’s classification to evaluate the practice of cesarean sections in order to identify the groups of women who had abnormally high rates. The objective of our study was to evaluate cesarean sections using the Robson’s classification in CHRACERH and in the Yaoundé Central Hospital (YCH). Methodology: We carried out a retrospective cross sectional and descriptive study in two (02) university hospitals in Yaoundé which took place from December 2017 to May 2018. We included in our study all women who gave birth over a period of two (02) years from January 2016 to December 2017 in these two health facilities. Our sampling was exhaustive over the study period. The parturients’ information was collected using an anonymous and pretested questionnaire. The Robson’s group of every parturient was determined. Descriptive parameters like mean and proportions were calculated. We compared the rates and indications of cesarean sections between the both hospitals using Chi<sup>2</sup> test. Results: Out of 330 deliveries realized in CHRACERH, we had 90 cesarean sections;hence, a rate of 27.2%. Out of 1863 deliveries carried out at the YCH, 462 were by cesarean section, hence a rate of 24.8%. The women who belonged to groups 1, 3 and 5 contributed to the highest rates of cesarean sections in both hospitals: in CHRACERH, group 5 (31.1%), group 3 (20%) and group 1 (15.6%), at YCH: group 3 (22.5%), group 1 (21.6%) and group 5 (17.3%). The indications of the cesarean sections varied depending on the Robson’s group and the hospital, the principal indication in group 1 was acute fetal distress (28.6%) in CHRACERH and cephalopelvic disproportion (36.7%) at YCH. Cephalopelvic disproportion was the predominant indication in groups 3 of CHRACERH (44.4%) and YCH (39.2%). In groups 5, CHRACERH and of YCH, a scarred uterus was the principal indication for the cesarean section at 82.4% and 78.4% respectively. At CHRACERH, the maternofetal complications were more frequent in groups 1 and 2 at the YCH, this was the case mostly in groups 1 and 3. Conclusion: The Robson’s classification is an adequate tool for the evaluation and comparison of the rates of cesarean sections. The rates of cesarean section in CHRACERH (27.2%) and at YCH (24.8%) were higher than the rates recommended by WHO. Robson’s groups 1, 3 and 5 were identified as the groups most at risk for cesarean sections in the both hospitals.
文摘<strong>Background:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Quality assurance in labor and delivery is needed. The method must be simple and consistent, and be of universal value. The 10-Group Classification System is a simple method providing a common starting point for further detailed analysis within which all perinatal events and outcomes can be measured and compared. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> The purpose of this study was to analyze cesarean section (CS) rates using the classification system of Robson’s ten groups and to identify the main contributors to the overall CS rate in Burkina Faso’s regional and university hospitals. </span><b><span style="font-family:Verdana;">Materials and Method:</span></b><span style="font-family:Verdana;"> A cross-sectional study with retrospective collection was carried out. All women who gave birth between July 1, 2017 and June 30, 2018, in the Regional Hospital Centres (RHC) and University Hospital Centres (UHC) of Burkina Faso were classified according to the Robson ten-group method. The overall CS rates and in each Robson group were calculated, as well as the contribution of each group to the overall CS rate. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The CS rate was 26.5% (8543 out of 32,240 deliveries) during the study period. nulliparous women with single term pregnancy in cephalic presentation during spontaneous labour (group 1), multiparous women with single pregnancy in cephalic presentation, gestational age ≥37SA, spontaneous labour (group 3) and multiparous women with previous CS (group 5) were the main contributors (67.7%) to the overall CS rate. In addition, we observed a variation in CS rates between different hospitals, especially among women with full-term pregnancies in cephalic presentation without previous CS (groups 1 to 4), showing large differences in emergency obstetric and neonatal care across the country. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Women in groups 1, 3 and 5 were the most important contributors to the overall CS rate in Burkina Faso. It appears that efforts to reduce the overall rate of CS should focus on vaginal delivery on the scarred uterus, reduction of CS rates in nulliparous women with full-term pregnancy in cephalic presentation (groups 1) and proper monitoring of multiparous women with full-term pregnancy in spontaneous labour (group 3).</span></span>
文摘<strong>Introduction:</strong> <span><span><span style="font-family:""><span style="font-family:Verdana;">Caesarean section (CS) is a major reproductive health intervention to improve maternal and foetal outcomes if appropriately performed. </span><span style="font-family:Verdana;">This study aimed to assess the quality of Caesarean sections (CS) in a rural</span> <span><span style="font-family:Verdana;">setting in Cameroon. </span><b><span style="font-family:Verdana;">Materials and Methods: </span></b><span style="font-family:Verdana;">A prospective study con</span></span><span style="font-family:Verdana;">ducted in 3 hospitals from February 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> 2020 to April 30</span><sup><span style="font-family:Verdana;">th</span></sup><span style="font-family:Verdana;"> 2020. One hundred and twenty women who had a CS were included. Data were grouped into 5 categories: </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">1</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) Sociodemographic and obstetrical characteristics, </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">2</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) Geographic and financial access, </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">3</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) Diagnostic procedures, </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">4</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) Operative parameters and </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">5</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">) Post-operative parameters. The Dujardin’s model and context-relevant</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> criteria served to construct the quality score. The scale was 0 </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> 20 and scores ≤ 15 were considered as unacceptable quality while those >15 were considered as acceptable quality CS. Logistic regressions permitted to measure associations. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> There were 538 deliveries and 120 (22.3%) CS. The mean (SD) gestational age was 38.7 (2.6) weeks with extremes of 31 and 43 weeks. Group 5 of the Robson’s classification was predominant (35.0%). Motorbikes were the mode of transport to the maternity for 72.5% (87/120) of women. No referral was made by ambulance. Only 44 (36.7%) women had paid the full cost of the CS prior to surgery. In addition, 26 (21.6%) women had a complete clinical examination on admission. The surgical team was not complete (<6 staffs) in 56 (43.3%) cases. Anaesthesia was done by nurses in all cases. CS was done by a general practitioner and by nurses in 86 (71.7%) and 14 (11.7%) cases respectively. Overall, mean (SD) quality score (QS) was 16.33 (1.60).</span><b> </b><span style="font-family:Verdana;">Sixty six of the 120 (55.3%) caesarean sections had unacceptable quality CS. Mean (SD) QS was significantly higher in faith-based hospitals than in public hospitals (18.00 (0.91) versus 15.59 (1.24);P</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">0.001).</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Immediate </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">postoperative clinical monitoring was effective only in 66 (55%) of cases. Apgar score was below 7 over 10 in 17 (14.2%) cases of which 6 freshes still births. No maternal death was recorded and maternal complications were recorded in 14 (11.7%) cases. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">The quality of CS is generally poor in rural settings in West-Cameroon. The quantity and quality of staffs required for Caesarean sections in the hospitals are sometimes insufficient. The poor quality of CS in this region could be addressed using the faith-based hospitals: St Vincent de Paul’s Hospital as a model.</span></span></span></span>
