This powerpoint is a literature review on Cesarean Delivery by Maternal Request (CDMR). It introduces various birthing methods including cesareans and reports on the recent trends of cesarean delivery in the U.S. It then explores CDMR and the trends, issues, and concerns that surround it.
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
this presentation highlights the principles of uterine and ovarian transplantation. It explores the past and examines the current status for uterine and ovarian factor infertility.
Advance in diagnosis & treatment of cancers has led to high cure rate & longer survival.
Nearly 1 in 12 cases detected before 40 years age.
Survivors have to face infertility or early menopause.
OVERVIEW
Aim
Definition
Prerequisites
Individualisation of patient.
Ohss free IUI. Clinic
{Strict cancellation of cycle if OHSS is suspected}
Newer trends
Sucess Rates in IUI with COH
PROGNOTIC FACTORS to increase Pregnancy Rates..& discussion
PREGNANCY OF UNKNOWN LOCATION DR. SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BH...Lifecare Centre
PREGNANCY OF UNKNOWN LOCATION DR. SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BHASKAR
WHY THIS PPT ??
One of our of patient’s was discharged home with presumed COMPLETE miscarriage.
Subsequently returned with pain abdomen , bleeding & ruptured EP
…We thought of reviewing
PRENANCY OF UNKNOWN LOCATION
Robson classification Dr. Iqra Malik.pptJawad Awan
Cesarean section (CS) was introduced to obstetrical practice as a lifesaving procedure both for mother and her child. It gives an opportunity to evaluate the prevalence of CSs among various groups of women, to compare data between institutions, learn from each other and to create strategies for better results.
Based on the available knowledge, the Robson classification (the Ten-group classification system) meets the current needs the best.
Caesarean section (CS) rates have been increasing worldwide and have caused concerns. For meaningful comparisons to be made World Health Organization recommends the use of the Ten-Group Robson classification as the global standard for assessing CS rates.
Manegement of adenexal masses in pregnancyWafaa Benjamin
Over the last 20 years, the use of ultrasound in pregnancy has dramatically increased the numbers of ovarian cysts diagnosed.
The majority of these ovarian cysts in pregnancy either resolve spontaneously or are due to benign conditions.
Ovarian cancer is extremely rare in women of childbearing age and thus most of these cysts can be managed conservatively.
In terms of malignancy potential, those that are malignant are likely to be borderline.
Unless there is a suspicion of malignancy or there is a significant cyst complication, such as torsion, surgery is not indicated.
MRI is a safe and useful tool to help evaluate cysts in more detail in situations where ultrasound provides an inconclusive answer.
If surgery is planned, this should take place during the second trimester to minimise the risk of miscarriage.
Whether surgery is done laparoscopically or using a traditional open approach, it is largely dependent on operator experience and patient preference.
Aspiration of ovarian cysts is only indicated where they appear simple on ultrasound and where they are causing pain or are thought to be obstructing the birth canal.
If surgery does not take place, then ultrasound follow-up during and after pregnancy may be advised accordingly.
this presentation highlights the principles of uterine and ovarian transplantation. It explores the past and examines the current status for uterine and ovarian factor infertility.
Advance in diagnosis & treatment of cancers has led to high cure rate & longer survival.
Nearly 1 in 12 cases detected before 40 years age.
Survivors have to face infertility or early menopause.
OVERVIEW
Aim
Definition
Prerequisites
Individualisation of patient.
Ohss free IUI. Clinic
{Strict cancellation of cycle if OHSS is suspected}
Newer trends
Sucess Rates in IUI with COH
PROGNOTIC FACTORS to increase Pregnancy Rates..& discussion
PREGNANCY OF UNKNOWN LOCATION DR. SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BH...Lifecare Centre
PREGNANCY OF UNKNOWN LOCATION DR. SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BHASKAR
WHY THIS PPT ??
One of our of patient’s was discharged home with presumed COMPLETE miscarriage.
Subsequently returned with pain abdomen , bleeding & ruptured EP
…We thought of reviewing
PRENANCY OF UNKNOWN LOCATION
Robson classification Dr. Iqra Malik.pptJawad Awan
Cesarean section (CS) was introduced to obstetrical practice as a lifesaving procedure both for mother and her child. It gives an opportunity to evaluate the prevalence of CSs among various groups of women, to compare data between institutions, learn from each other and to create strategies for better results.
Based on the available knowledge, the Robson classification (the Ten-group classification system) meets the current needs the best.
Caesarean section (CS) rates have been increasing worldwide and have caused concerns. For meaningful comparisons to be made World Health Organization recommends the use of the Ten-Group Robson classification as the global standard for assessing CS rates.
Manegement of adenexal masses in pregnancyWafaa Benjamin
Over the last 20 years, the use of ultrasound in pregnancy has dramatically increased the numbers of ovarian cysts diagnosed.
The majority of these ovarian cysts in pregnancy either resolve spontaneously or are due to benign conditions.
Ovarian cancer is extremely rare in women of childbearing age and thus most of these cysts can be managed conservatively.
In terms of malignancy potential, those that are malignant are likely to be borderline.
Unless there is a suspicion of malignancy or there is a significant cyst complication, such as torsion, surgery is not indicated.
MRI is a safe and useful tool to help evaluate cysts in more detail in situations where ultrasound provides an inconclusive answer.
If surgery is planned, this should take place during the second trimester to minimise the risk of miscarriage.
Whether surgery is done laparoscopically or using a traditional open approach, it is largely dependent on operator experience and patient preference.
Aspiration of ovarian cysts is only indicated where they appear simple on ultrasound and where they are causing pain or are thought to be obstructing the birth canal.
If surgery does not take place, then ultrasound follow-up during and after pregnancy may be advised accordingly.
Clinical pelvimetry and Forceps Assisted Vaginal DeliveryArthur Greenwood
A review of clinical pelvimetry and its usefulness in determining if a operative vaginally delivery may be performed. Multiple types of forceps are reviewed. This is a must read for all obstetric providers.
As part of the Strong Start for Mothers and Newborns effort, the CMS Innovation Center hosted a webinar to discuss why it is important to reduce early elective deliveries and share best practices on how reducing early elective deliveries improves the health of mothers and newborns across the country. Individuals representing the American College of Obstetricians and Gynecologists, the March of Dimes, providers and payers conveyed examples of successes and how reducing early elective deliveries can be accomplished. All interested parties were invited to attend this event.
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http://innovations.cms.gov
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1
DOES THE UNITED STATES NEED MORE MIDWIIVES?
Does the United States need more Midwives?
Madison Courtney
Georgetown College
Author Note
This paper was prepared for English 125, taught by Professor Burch
Abstract
Does the United States need more midwives? This is the question this paper will explore by looking at the fact that the US has a very high newborn mortality rate and that we use more OB-GYNs for deliveries than any other country. I find that there is a correlation between OB-GYNs and the high infant mortality rate due to the fact that OB-GYNs are surgeons and they use surgery (cesarean sections) that is a lot more risky than a vaginal birth. Midwives only use surgery when necessary and their less risky tactics lead to lower newborn death rates or labor complications. Therefore, I concluded that the United States does need more midwives.
Does the United States need more Midwives?
The United States newborn death rate is the second highest in the world, this is a fact that many people are unaware of today. With the amount of money the US spends on healthcare, we should not have a rate this high. Because OB-GYNs are used more in the US than any other country, you have to wonder if there was a correlation between the two. After research, I have found a correlation between OB-GYNs and newborn death rate because of labor interventions that lead to cesarean sections. Midwives don’t have the same outcome as OB-GYNs. Midwives aren’t as quick to use interventions and their cesarean section rate is a lot lower than OB-GYNs leading to lower risk labors and therefore a lower newborn death rate. Therefore, the US needs more midwives.
Literature Review
In a documentary by Lake it is said that among 33 industrialized nations, the United States is tied with Hungary, Malta, Poland and Slovakia with a death rate of nearly 5 per 1,000 babies, according to a report from Save the Children (April 2006). This is the second worst newborn death rate in the developed world. The five countries with the lowest infant mortality rates (Japan, Singapore, Sweden, Finland and Norway) midwives were used as their main source of care for 70 percent of the birthing mothers (2008).
Cesarean sections have many more risks than vaginal births. C-sections are more likely to occur because of the interventions during labor. Pitocin is a common intervention that puts the baby in stress during labor, which leads to a cesarean section. OB-GYNs are a lot more likely to use these interventions than midwives. Lewis Mehl-Madrona, MD, PhD, coordinator of Integrative Psychiatry and Systems Medicine at the University of Arizona College of Medicine Program in Integrative Medicine, comparing 1,046 home births to 1,046 hospital births found negative outcomes consistently higher in hospital births. These included a fetal distress rate six times higher in hospitals, a respiratory distress rate 17 times higher in hospitals, babies requiring resuscitatio.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
6. Types of Cesareans
• Emergency: procedures initiated after labor has
begun due to complications with vaginal delivery
Collard, T., et al. (2008). Cesarean Section. Why women choose it and what nurses need to know. Nursing forWomen’s Health. 12:6. 480-88.
8. Recent Trends of
Cesarean Delivery in the
U.S. 1996-2007
• Dramatic increases in cesareans, rising 53%
• Increases across all demographics race,
ethnicity, age, and socioeconomic status
• Increases for infants of all gestational ages with
preterm infants increasing the greatest
• Increases in all 50 states with rates rising over
70% in six U.S. states
Menacker, F., Hamilton, B.E. (2010). Recent trends in cesarean delivery in the United States. NCHS Data Brief. 35. National Center for Health Statistics.1-8.
10. Recent Trends in Cesarean
Delivery in the U.S.
35
Cesareans per 100 live births
30
25
20
15
1991 1995 1999 2003 2007
Year
Figure 1. Cesarean delivery rates in the United States, 1991-2007. Source: CDC/NCHS. National Vital
Statistics System.
Menacker, F., Hamilton, B.E. (2010). Recent trends in cesarean delivery in the United States. NCHS Data Brief. 35. National Center for Health Statistics.1-8.
11. Birthing Methods In
the U.S.
Primary Elective Pre-Labor Cesarean Delivery as a
percentage of all Cesarean Deliveries in the US in 2001
28%
Cesarean Births
"Primary Elective" Pre-Labor
Cesearean Births
72%
National Institutes of Health State-of-the-Science Conference Statement on Cesarean Delivery on Maternal Request.(2006) NIH Consensus Science Statements.
23 (1) 1-29.
12. Why the Rise?
• Multiparious Women
– More repeat cesarean
– Less VBAC procedures
• Advancement in Technology
– More multiple Births due to fertility treatment
– More older women giving birth
– More inductions
• Physician Driven Factors
– Physician Practice Patterns
– Physician Convenience
– Legal Pressures
• Maternally Driven Factors
– Cesarean Delivery on Maternal Request (CDMR)
Menacker, F., Hamilton, B.E. (2010). Recent trends in cesarean delivery in the United States. NCHS Data Brief. 35. National Center for Health Statistics.1-8.
13. Should Rising Cesarean
Rates Be a Concern?
• In 2007, 1.4 million women had cesarean birth
– Number of cesarean births has increased 71% since 1996
• Cesarean Sections are major abdominal surgery
– Associated with higher rates of
• Surgical complications
• Maternal re-hospitalization
• Complications requiring neonatal ICU admission
– Associated with higher costs
• Nearly double that of vaginal birth
National Institutes of Health State-of-the-Science Conference Statement on Cesarean Delivery on Maternal Request.(2006) NIH Consensus Science Statements.
23 (1) 1-29.
Collard, T., et al. (2008). Cesarean Section. Why women choose it and what nurses need to know. Nursing forWomen’s Health. 12:6. 480-88. Menacker, F.,
Hamilton, B.E. (2010). Recent trends in cesarean delivery in the United States. NCHS Data Brief. 35. National Center for Health Statistics.1-8.
14. Projected Trends in
Cesarean Delivery in the
U.S.
40
Cesareans per 100 live births
R² = 0.74127
35
30
25
20
15
1991 1995 1999 2003 2007 2011 2015
Year
Figure 1. Cesarean delivery rates in the United States, 1991-2007. Source: CDC/NCHS. National Vital
Statistics System.
Menacker, F., Hamilton, B.E. (2010). Recent trends in cesarean delivery in the United States. NCHS Data Brief. 35. National Center for Health Statistics.1-8.
15. What is Cesarean Delivery
on Maternal Request
(CDMR)?
• CDMR: a cesarean delivery for a singleton pregnancy on
maternal request at term in the absence of any medical or
obstetric indications.
• Why is CDMR difficult to define?
– Not easily identifiable
• What descriptions are included in CDMR?
– Cesarean delivery with no labor or medical indication
– Cesarean delivery with “no indicated risk”
– Cesarean section by choice (CSBS).
National Institutes of Health State-of-the-Science Conference Statement on Cesarean Delivery on Maternal Request.(2006) NIH Consensus Science Statements.
23 (1) 1-29.
Collard, T., et al. (2008). Cesarean Section. Why women choose it and what nurses need to know. Nursing forWomen’s Health. 12:6. 480-88.
17. Birthing Methods in
the U.S.
Birthing Method Prevalence Per 100 Live Births in U.S.
2001
5% 2%
Non-Cesarean Births
17%
Cesarean Births
Cesarean with "no indicated
risk"
Cesarean with no labor or 76%
medical indication
National Institutes of Health State-of-the-Science Conference Statement on Cesarean Delivery on Maternal Request.(2006) NIH Consensus Science Statements.
23 (1) 1-29.
20. Projected Trends in
Cesarean Delivery in the
U.S.
Projected Trends of Cesarean Section with "No
Indicated Risk" and "No Labor or Medical Indication"
10
9 R² = 1
8
7
6
5.5 Linear(No Indicated Risk)
5 R² = 0.78593
4 Linear(No labor or
3 3.3 Linear(No Labor or Medical
2
2.6 Indication)Indication)
Medical
1.9
1
0
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
2015
2017
National Institutes of Health State-of-the-Science Conference Statement on Cesarean Delivery on Maternal Request.(2006) NIH Consensus Science Statements.
23 (1) 1-29.
21. World Health Organization
(WHO) On CDMR
• Recommends a cesarean rate of 15% in developed nations.
• “Unnecessary cesarean section is a classic example of the
mismatch between evidence and practice in obstetrics.”
• The increasing cesarean rate does not automatically lead to
better outcomes and could be associated with harm.
• Cesarean section with no medical indication is associated with
with increased risk of maternal mortality and morbidity.
• Cesarean section for breech presentation is associated with
improved perinatal outcomes.
• Mothers who choose cesareans need to make the decision
informed of the increased risks.
Lumbiganon, Pisake, et al. (2010).Method of delivery and pregnancy outcomes in Asia: the WHO Global Survey on maternal and perinatal health
2007-08. The Lancet.375. 490-499.
Villar, J. et al. (2006). Cesarean delivery rates and pregnancy outcomes in the WHO Global Survey for monitoring maternal and perinatal health in Latin
America.The Lancet. 367. 1819-29.
22. Federation of Obstetrics &
Gynecology (FIGO) on CDMR
• CDMR is not ethically justified.
• Factors: medical, legal, psychological, social, and financial.
• Surgical intervention with potential risks to mother and child.
• It uses more resources than vaginal delivery.
• Physician duty not to harm and to allocate resources wisely.
• No hard evidence on risks/benefits of CDMR
• Vaginal delivery is safest for mother and child.
• “Natural concern at introducing an artificial method of
delivery in place of the natural process with out medical
justification.”
Christlaw, J.E. (2006). Cesarean section by choice: Constructing a reproductive rights framework for the debate. International Journal or Gynecology and
Obstetrics. 94. 262-268.
23. American College of
Obstetrics and Gynecology
(ACOG) on CDMR
• Currently a lack of conclusive data for benefits/
risks.
• “Burden of proof ” lies on CDMR advocates.
• Ethical justification for CDMR depends on how it
will effect the overall health of the woman and her
fetus.
• Not ethically necessary to include CDMR in
discussions of birthing options for every patient.
Surgery and patient choice: The ethics of decision making. (2003) ACOG Committee Opinion 289. International Journal of Gynecology & Obstetrics. 84. 188-93.
24. Recent Trends of
Cesarean Delivery on
Maternal Request (CDMR)
• Cesarean delivery with “no risk indicated”
– Rose from 3.3% of live births in 1991 to 5.5% in 2001
• Cesarean delivery with no labor or medical indication
– Rose from 1.9% of live births in 2001 to 2.6% in 2003
• Cesarean delivery by choice
– Italy: Rose from 4.5% in 1996 to 9% in 2000
– Sweden: Rose 8.9% in 1994 to 15.8% in 1995
– Taiwan: Rose from 2% in 1997 to 3.5% in 2001
• Rates may be lower because costs of cesareans are reimbursed at the
lower vaginal delivery cost.
National Institutes of Health State-of-the-Science Conference Statement on Cesarean Delivery on Maternal Request.(2006) NIH Consensus Science Statements.
23 (1) 1-29.
25. So, Why are more women
requesting Cesareans?
Possible Reasons May Include:
• Fear of…
– Birth experience
• Pain
• Terror Management (i.e. previous adverse birth experience)
– Potential maternal consequences
• pelvic organ prolapse
• Urinary and anal incontinence
• Sexual side-effects
• needing an emergency C-section
– Potential fetal consequences
• Health of baby (i.e. birth defects; complications from birth)
• Potential death of baby during birth
• Control and Convenience
– Scheduling
Fenwick, J., et al. (2009). Pre- and postpartum levels of childbirth fear and the relationship to birth outcomes in a cohort of Australian women. Journal of Clinical
Nursing. 18, 667-77.
Kjærgaard, H., et al. (2008). Fear of childbirth in obstetrically low-risk nulliparous women in Sweden and Denmark. Journal of Reproductive and Infant Psychology.
26:4, 340-350.
26. So, Why are more women
requesting Cesareans?
Possible Reasons May Include:
• Fear of…
– Birth experience
• Pain
• Terror Management (i.e. previous adverse birth experience)
– Potential maternal consequences
• pelvic organ prolapse
• Urinary and anal incontinence
• Sexual side-effects
• needing an emergency C-section
– Potential fetal consequences
• Health of baby (i.e. birth defects; complications from birth)
• Potential death of baby during birth
• Control and Convenience
– Scheduling
Fenwick, J., et al. (2009). Pre- and postpartum levels of childbirth fear and the relationship to birth outcomes in a cohort of Australian women. Journal of Clinical
Nursing. 18, 667-77.
Kjærgaard, H., et al. (2008). Fear of childbirth in obstetrically low-risk nulliparous women in Sweden and Denmark. Journal of Reproductive and Infant Psychology.
26:4, 340-350.
27. Suggestions for
moving forward
Include a check
box for
“maternal CDMR data is vague
request” on birth
certificates. - practices in the collection of data by
institutions and the government
Lack of standardized
definition of CDMR
and use of proxies in
the literature.
CDMR findings are indirect
- limiting availability of data
28. Suggestions for
moving forward
After proper data collection is established:
- Research trends of CDMR
- Possible relationships of CDMR and other
variables
-Possible reasons why women are requesting
CDMR
- Design interventions to address concerns that
become apparent.
29. Suggestions for
Develop moving forward
interventions to
address
psychological Fear of pain during birth experience
needs of mothers
and CDMR as a terror management
Implement health
technique.
interventions to
increase
knowledge and
Fear surrounding the birth experience
dispel uninformed
fear of birth.
and possible maternal and neonatal
physical consequences.
Education on the
risks and benefits
associated with any All mothers who request CDMR
cesarean section
should be informed.
30. THANK YOU
Pregnancy and Labor Resources
www.marchofdimes.com www.ican-online.org
www.childbirthconnection.org