Recent trends of interventions in labor management at a tertiary care hospital

Nidhi D. Thakkar; Sonali N. Agarwal

doi:10.18203/2320-1770.ijrcog20241424

Authors

Nidhi D. Thakkar Department of Obstetrics and Gynaecology, Baroda Medical College, Vadodara, Gujarat, India
Sonali N. Agarwal Department of Obstetrics and Gynaecology, Baroda Medical College, Vadodara, Gujarat, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20241424

Keywords:

Recent trends, C-section, TOLAC, Transfusion

Abstract

Background: Aim of the study were to identify the changing trends in labor management in terms of rate of cesarean section (C-section), rate of trial of labor after C-section (TOLAC), rate of primary and repeat C-section, rate of episiotomy in primi and multi-gravida and percentage contribution of red cell concentrate (RCC) to total blood transfusion.

Methods: The data was collected retrospectively for every year at SSG hospital, Baroda from 1^st January 2014 to 31^st December 2022. C-section rate was calculated per annum in percentage, which was again split into primary and repeat C-section rate. Leading indications for primary C-section were identified. Rate of total episiotomy, in primigravida and multigravida, trends of RCC transfusion rates and its contribution to total blood products were estimated. Appropriate statistical tests were applied to check level of significance.

Results: C-section rate contributing to total confinements increased from 30.76% in 2014 to 37.6% in 2022, which was statistically significant. Contribution by primary C-section has decreased but repeat C-section has increased over these years. Common indications for primary C-section included fetal distress, MSL, breech presentation, non-progression of labor etc. Overall rate of episiotomy has increased from 41% in 2104 to 54.4% in 2022, with decrease in primigravida and increase in multigravida over these years but these rates are not significantly changed. Contribution of RCC to total transfusion significantly decreased from 76.1% in 2014 to 66% in 2022.

Conclusions: Rate of total and for repeat C-section are increasing with time, so TOLAC and other strategies to reduce primary C-section should be focused upon. Episiotomy must not be routine and should be given when indicated only. Interventions to reduce requirement of blood transfusion must be strengthened. New oral and parenteral iron preparations should be accepted based on evidences.

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References

Roy N, Mishra PK, Mishra VK, Chattu VK, Varandani S, Batham SK. Changing scenario of C-section delivery in India: Understanding the maternal health concern and its associated predictors. J Family Med Primary Care. 2021;10(11):4182-8.

Betran AP, Ye J, Moller A-B, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Global Health. 2021;6(6):e005671.

Simmons E, Lane K, Rao SR, Kurhe K, Patel A, Hibberd PL. Trends in cesarean section rates in private and public facilities in rural eastern Maharashtra, India from 2010-2017. PLoS One. 2021;16(8):e0256096.

Goyal N, Pandey H. Changing trends of indication of cesarean section. Int J Reprod Contracept Obstet Gynecol. 2020;9(7):2721-4.

Osterman MJK. Changes in primary and repeat cesarean delivery: United States, 2016-2021. Vital Statistics Rapid Release; no 21. Hyattsville, MD: National Center for Health Statistics. 2022.

Patrícia ML, Machado AKF, Cesar JA. Recent trends in cesarean section reduction in extreme south of Brazil: a reality only in the public sector? Cien Saude Colet. 2022;27(8):3307.

Goueslard K, Cottenet J, Roussot A, Clesse C, Sagot P, Quantin C. How did episiotomy rates change from 2007 to 2014? Population-based study in France. BMC Pregnancy Childbirth. 2018;18(1):208.

Jiangfeng Y, Chen Y, Yang H, Chen Q, Huang Y, Zhao J, et al. A nationwide cross-sectional survey of episiotomy practice in China. Lancet Regional Health: Western Pacific. 2021;19:100345.

Mandelbaum DA, Rudasil SE, Aguayo E, Chan E, Sanaiha Y, Cohen JG, et al. National Trends in Utilization of Episiotomy and Factors Associated with High-Utilization Centers in the United States. J Women’s Health Dev. 2021;4(3):082-94.

Teixeira C, Lorthe E, Barros H. Time trends in episiotomy and severe perineal tears in Portugal: a nationwide register-based study. BMC Pregnancy Childbirth. 2022;22(1):976.

Singh RK, Anne S, Ravindran SP. Changing trends of blood transfusion requirement in obstetrics and gynaecology. Int J Reprod Contracept Obstet Gynecol. 2018;7:2018-22.

Xie Y, Liang J, Mu Y, Liu Z, Wang Y, Dai L, et al. Incidence, trends and risk factors for obstetric massive blood transfusion in China from 2012 to 2019: an observational study. BMJ Open. 2021;11(9):e047983

Chawla S, Bal MHK, Vardhan BS, Jose CT, Sahoo I. Blood Transfusion Practices in Obstetrics: Our Experience. J Obstetr Gynaecol India. 2018;68(3):204-7.

Fazal S, Poornima AP. A study on transfusion practice in obstetric hemorrhage in a tertiary care centre. Global J Transfusion Med. 2018;3(1):41-5.