Caesarean section

Development and design of a Delphi protocol to produce a consensus core information set for caesarean section (2025)

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Type of publication:

Conference abstract

Author(s):

Greenfield B.; *Elsmore A.; Frizelle J.; Bradley F.; Kingdon C.; Merriel A.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BMFMS Abstracts 2024. Liverpool United Kingdom. 132(Supplement 1) (pp 70), 2025. Date of Publication: 01 Jan 2025.

Abstract:

Objectives: Core information sets are a standardised way to guide discussions with patients to aid decision making for surgical procedures. 1-3 Informed decision making is foundational for ensuring women have agency and autonomy towards their pregnancy and reproductive choices.4 This work will produce a consensus expert opinion, via a Delphi method,5 of relevant information necessary for decision making regarding caesarean sections. Method(s): A scoping review of peer-reviewed publications was undertaken using electronic databases, alongside internet searches for patient information relating to caesarean section. Qualitative and mixed-method studies were reviewed to inform domains and questions. Think Aloud interviews with stakeholders (healthcare professionals and lay people) were conducted to ensure correct syntax and legibility, prior to Delphi distribution. Result(s): A total of 305 studies were identified, from which 345 information points were collected. Patient information leaflets, focus-group interviews, and surveys identified 60, 54 and 12 separate points, respectively. These were collated into 64 questions across 11 domains including indications, risks/benefits, and patient experience of elective/emergency caesarean sections. These questions were refined by 7 Think Aloud interviews until no further changes were identified. The resultant online Delphi (REDCap) is ready for distribution. There will be two rounds prior to a stakeholder consensus meeting in Q1 2024. Conclusion(s): The need for a core information set for caesarean section is evidenced by the disparate nature of current decision aids and proliferation of public information. This work has produced an information set ready for prioritisation by a Delphi panel to provide consistent information regarding caesarean sections.

DOI: 10.1111/1471-0528.18006

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Development of a core information set for caesarean section - A scoping review of patient information leaflets (2025)

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Type of publication:

Conference abstract

Author(s):

*Elsmore A.; Merriel A.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BMFMS Abstracts 2024. Liverpool United Kingdom. 132(Supplement 1) (pp 56-57), 2025. Date of Publication: 01 Jan 2025

Abstract:

Objectives: Good clinical practice mandates that women have full choice and autonomy for their care in pregnancy and childbirth and are armed with key information points to facilitate informed decision making.1 Development of a core information set will allow women to access consistent, accurate information, containing facts that are important to them.2 As part of this work, a scoping review of patient information leaflets was performed to identify information points. Method(s): We performed an internet search for patient information leaflets, articles, and electronic information sources, such as national and international medical, midwifery, or nursing organisations, from health providers (e.g. NHS), and non-governmental organisations. The search terms were 'caesarean section', 'caesarean section UK', and 'caesarean section patient information leaflet'. Data points were extracted and entered into a database in Microsoft ExcelTM. Result(s): Information points were extracted from 50 sources with 60 separate information points collected. Data collection ceased at 50 sources as saturation was reached. Sources included national organisations, trust patient information leaflets, private care providers, and patient organisations. The number of information points per source ranged from 2 to 40. The type of anaesthetic was the most common information point found, in 78% of sources (39/50); the least common was increased risk of neonatal death in first 28 days in 2% of sources (1/50). Conclusion(s): A large degree of heterogeneity of information points within patient information leaflets was noted, reinforcing the need for the development of a core information set for caesarean section. Women must be provided with consistent information regarding different types of delivery

DOI: 10.1111/1471-0528.18006

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Babies in occiput posterior position are significantly more likely to require an emergency cesarean birth compared with babies in occiput transverse position in the second stage of labor: A prospective observational study (2020)

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Type of publication:
Journal article

Author(s):
Tempest, Nicola; Lane, Steven; Hapangama, Dharani; UK Audit Ressearch Trainee Collaborative in Obstetrics, Gynecology (UK-ARCOG) (*William Parry-Smith is a core committee member of UK-ARCOG)

Citation:
Acta Obstetricia et Gynecologica Scandinavica; Apr 2020; vol. 99 (no. 4); p. 537-545

Abstract:
INTRODUCTION Malposition complicates 2-13% of births at delivery, leading to increased obstetric interventions (cesarean section and instrumental delivery) and higher rates of adverse fetal and maternal outcomes. Limited data are available regarding the likely rates of obstetric intervention and subsequent neonatal and maternal outcomes of births with babies in persistent occiput posterior position vs those in persistent occiput transverse position. The UK Audit and Research trainee Collaborative in Obstetrics and Gynecology (UK-ARCOG) network set out to collect data prospectively at delivery on final mode of delivery and immediate outcomes.MATERIAL AND METHODS The UK-ARCOG network collected data on all births with malposition of the fetal head complicating the second stage of labor (n = 838) (occiput posterior/occiput transverse) requiring rotational vaginal operative birth or emergency cesarean to expedite delivery across 66 participating UK National Health Service maternity units over a 1-month period. The outcomes considered were the need for emergency cesarean section without a trial of instrumental delivery, success of the first method of delivery employed in achieving a vaginal delivery and neonatal/maternal outcomes.RESULTS Obstetricians regarded assistance with an operative vaginal delivery method to be unsafe in 15% of babies in occiput posterior position and 6.1% of babies in occiput transverse position, and they were delivered by primary emergency cesarean section. When vaginal delivery was deemed safe (defined as attempted assisted vaginal rotational delivery), the first instrument attempted was successful in 74.4% of occiput posterior babies and 79.3% of occiput transverse babies.CONCLUSIONS Our data facilitates decision making by obstetricians to increase safety of assisted rotational operative delivery of a malpositioned baby at initial assessment and in counseling women. Until data from a well-designed randomized controlled trial of instrumental delivery vs emergency cesarean section are available, this manuscript provides contemporaneous national data from a high resource setting within a structured training program, to assist the selection of an appropriate instrument/method for the delivery of a malpositioned baby.

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The effect of male fetal gender on the cesarean section rate in greek women with induced labor (2019)

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Type of publication:
Journal article

Author(s):
Antonakou A.; Souma M.; Tsourlou E.; *Papoutsis D.

Citation:
Archives of Hellenic Medicine; 2019; vol. 36 (no. 5); p. 643-649

Abstract:
OBJECTIVE To explore the effect of fetal gender on the mode of delivery in women with induced labor.
METHOD We collected data retrospectively on women who underwent induction of labor in a tertiary Greek hospital over a one-year period. The maternal demographic characteristics, details of labor and delivery, and neonatal data were retrieved from the medical records. Multiple logistic regression analysis was used to identify whether or not the fetal gender was an independent risk factor for cesarean section (CS). RESULTS The sample consisted of 359 women with a mean age of 30+/-5.4 years. Maternal characteristics were similar in women who delivered male and female babies. The birth weight was significantly greater in male than female babies. A significantly higher CS rate was recorded in women with male babies than in those with female babies (39.4% vs 25.5%). Multiple regression analysis showed that the male fetal gender increased almost two-fold the risk of CS, even after adjusting for birth weight (OR=2.04, 95% CI: 1.11-3.76; p=0.022).
CONCLUSIONS We showed in this study that the male fetal gender is a factor that might affect the mode of delivery in women with induced labor. This gender relationship persisted after adjusting for birth weight, indicating that factors other than birth weight could explain this effect.

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The incidence of and risk factors for complications when removing a single uterine fibroid during cesarean section: a retrospective study with use of two comparison groups (2020)

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Type of publication:
Journal article

Author(s):
Sparic R.; Kadija S.; Spremovic Radjenovic S.; Lackovic M.; Bukumiric Z.; *Papoutsis D.; Malvasi A.; Tinelli A.

Citation:
Journal of Maternal-Fetal and Neonatal Medicine; Oct 2020; vol. 33 (no. 19); p. 3258-3265

Abstract:
Purpose: To determine the incidence of and risk factors for perioperative complications in women with a single uterine fibroid, who had a cesarean myomectomy (CM). Method(s): This was a retrospective study of women who had a CM between 2015-2016. They were compared versus women who had a cesarean section (CS) alone and nonpregnant women who had a laparotomic myomectomy (LM). Result(s): We identified 44 CM women, 51 CS patients, and 44 LM women. Those with a CM in most cases had subserosal at the anterior uterine wall and near the lower uterine segment (LUS), as most frequent fibroids; moreover, they had, on average, 18 min longer surgery duration versus CS alone. CM did not affect the Apgar scores and the incidence of minor and major complications was 36.4% and 29.5%, with the most frequent being postoperative anemia (36.4%) and intraoperative hemorrhage (29.5%). No significant differences were reported on both minor and major complications in the three groups. The following variables were found to be significant predictors in univariate logistic regression analysis for the occurrence of major complications in women who had a CM: the fibroid size (OR = 1.040, 95%CI: 1.014-1.066, p =.002), and duration of surgery (OR = 1.059, 5%CI:1.012-1.108, p =.013). The fibroid diameter cut-off was 75.0 mm (sensitivity 69.2%; specificity 90.3%), and the surgery duration was 87.5 min (sensitivity 53.8%; specificity 93.5%). Conclusion(s): CM appears safe, with no additional risks when compared to CS alone and LM in the women of reproductive age.

The SaTH risk-assessment tool for the prediction of emergency cesarean section in women having induction of labor for all indications: a large-cohort based study. (2017)

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Type of publication:
Journal article

Author(s):
*Papoutsis, Dimitrios, Antonakou, Angeliki, *Gornall, Adam, Tzavara, Chara, *Mohajer, Michelle

Citation:
Archives of Gynecology and Obstetrics, Jan 2017, vol. 295, no. 1, p. 59-66

Abstract:
To develop a risk-assessment model for the prediction of emergency cesarean section (CS) in women having induction of labor (IOL). This was an observational cohort study of women with IOL for any indication between 2007 and 2013. Women induced for stillbirths and with multiple pregnancies were excluded. The primary objective was to identify risk factors associated with CS delivery and to construct a risk-prediction tool. 6169 women were identified with mean age of 28.9 years. Primiparity involved 47.1 %, CS rate was 13.3 % and post-date pregnancies were 32.4 %. Risk factors for CS were: age >30 years, BMI >25 kg/m2, primiparity, black-ethnicity, non post-date pregnancy, meconium-stained liquor, epidural analgesia, and male fetal gender. Each factor was assigned a score and with increasing scores the CS rate increased. The CS rate was 5.4 % for a score <11, while for a score ≥11 it increased to 25.0 %. The model had a sensitivity, specificity, negative predictive value and positive predictive value of 75.8, 65.1, 93.8 and 25.0 %, respectively. We have constructed a risk-prediction tool for CS delivery in women with IOL. The risk-assessment tool for the prediction of emergency CS in induced labor has a high negative-predictive value and can provide reassurance to presumed low-risk women.