Caesarean Section
Conditions
Keywords
caesarean section, Robson classification, normal vaginal delivery, VBAC, reproduction, maternal health, Bangladesh
Brief summary
The objective of this study was to assess whether a package of 11 evidence-based maternity practices, combined with routine monitoring and Robson Classification, could reduce C-section rates in a semi-urban hospital in Dhaka, Bangladesh. Our intervention targeted the key drivers of unnecessary caesarean section at CWCH: weak labour monitoring, low use of evidence-based induction/vaginal birth after caesarean (VBAC) criteria, limited consultant oversight of C-section indications, and insufficient antenatal counselling.
Interventions
OTHERPackage of 11 evidence-based maternity practices combined with Robson TGCS Classification
The intervention package comprised 11 evidence-based maternity practices designed to reduce unnecessary C-sections and promote safe vaginal deliveries: 1. ANC counselling for expecting mothers. 2. Waiting up to 41 weeks of gestation for spontaneous onset of labour. 3. Risk screening for NVD and induction of labour at term. 4. Assessment of Bishop Score on admission. 5. Supportive care during labour and delivery. 6. Continuous monitoring with CTG. 7. Use of partograph 8. Induction or augmentation of labour as indicated, using prostaglandin or oxytocin for induction, based on Bishop Score. 9. Consultant review of CS indications during ward rounds. 10. Vaginal birth after caesarean (VBAC) for selected cases with appropriate monitoring. 11. Immediate care of the newborn. Additionally, all deliveries were classified using the Robson Ten Group Classification System.
Sponsors
Ashulia Women and Children Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Healthy volunteers
No
Inclusion criteria
\- Admitted into the maternity and labour ward of AWCH for delivery.
Exclusion criteria
* Unable to provide consent * Age is less than 18 years * Refused to participate in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Caesarean section rate | 70 weeks | Proportion of caesarean sections among total deliveries |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Absolute and non-absolute indications for caesarean sections | 70 weeks | Proportion of absolute and non-absolute indications among all deliveries by caesarean sections. Absolute indications are situations where vaginal delivery is not possible or poses a highly significant risk to the mother or baby. Non-absolute indications are situations where a caesarean section might be considered based on the potential risks and benefits for both the mother and the baby, and vaginal delivery may still be an option. Absolute indications include: obstructed labour, grade 3 or 4 placenta praevia, impending uterine rupture, and malpresentation. Non-absolute indications include: failure to progress in labour, prolonged labour, failed induction, previous caesarean delivery, antepartum haemorrhage, preeclampsia/eclampsia, psychological indication, maternal request, precious (valuable) pregnancy, foetal compromise, and breech presentation. |
| Robson classification for all deliveries | 70 weeks | Robson classification for all deliveries. The Robson classification is a system for classifying pregnant women who undergo childbirth. There are a total of 12 mutually-exclusive groups and subgroups to which every delivering mother is assigned to. These are: 1 Nulliparous, single cephalic, \>=37 weeks, spontaneous labour; 2a Nulliparous, single cephalic, \>=37 weeks, induced labour; 2b Nulliparous, single cephalic, \>=37 weeks, CS before labour; 3 Multiparous (no previous CS), single cephalic, \>=37 weeks, spontaneous labour; 4a Multiparous (no previous CS), single cephalic, \>=37 weeks, induced labour; 4b Multiparous (no previous CS), single cephalic, \>=37 weeks, CS before labour; 5 Multiparous, previous CS, single cephalic, \>=37 weeks; 6 Nulliparous with single breech; 7 Multiparous with single breech (including previous CS); 8 All multiple pregnancies (including previous CS); 9 All abnormal lies (including previous CS); 10 All single cephalic, \<37 weeks (including previous CS). |
| Absolute CS rate by Robson Classification | 70 weeks | Absolute proportion of caesarean sections among all Robson groups. Absolute rate is calculated by: number of caesarean section in the Robson group/total number of deliveries in the hospital \* 100 |
| Relative CS rate by Robson Classification | 70 weeks | Relative proportion of caesarean sections among all Robson groups. Relative rate is calculated by: number of caesarean sections in the Robson group/total number of caesarean sections in the hospital \* 100 |
Countries
Bangladesh
Outcome results
None listed