لتقليل معد ل الولادات القيصريه

1. Safaa Soliman Ahmed
Lecturer of Maternal and Newborn Health Nursing
Faculty of Nursing – Beni-Suef university

2. A New Call for the Prevention of
Primary Cesarean Delivery

3. Introduction
Worldwide rise in cesarean section
(CS) rate during the last three decades,
has been the cause of alarm and needs
an in depth study. CS is one of the
most common major surgical
procedure in private sector health care
services. The CS epidemic is a reason
for immediate concern and deserves
serious international attention

4. Balancing risks and benefits
Cs can be lifesaving for the fetus,
the mother , or both in certain
cases
For placenta previa or uterine
rupture:
Cs is firmly established as safest
route of delivery .

5. For low risk pregnancy cs has greater risk of
maternal morbidity and mortality than VD
 Risk of sever maternal morbidities:
hge that requires hysterectomy or transfusion,
Uterine rupture

6. hospital wound disruption Anesthetic
complication :shock .cardiac arrest,
acute renal failure , assisted ventilation
Venous thromboembolism
Major infection in wound or
hematoma compared with VD

7. Long term risks associated with cs
Placental abnormalities
Placenta previa , in future
pregnancies increases with each
sub sequent CS ,from 1%with 1
prior Cs to 3% with 3 prior CS.
After 3 CS , the risk of placenta
privea will be complicated by
placenta accreta is nearly 40%

8. Neonatal complications
Neonatal intensive care unit
admission
Perinatal death .

9. The American College of
Obstetricians and Gynecologists and
the Society for Maternal-Fetal
Medicine identify many ways to
safely reduce the chance of cesarean
birth. They focus on preventing
“primary” or initial cesareans in
pregnant women who have never
had a cesarean

10. In 2011, one in three women who gave
birth in the United States did so by
cesarean delivery
However, the rapid increase in cesarean
birth rates . from 1996 to 2011 without clear
evidence of concomitant decreases in
maternal or neonatal morbidity or mortality
raises significant concern that cesarean
delivery is overused

11. Therefore, it is important for health
care providers to understand the short-
term and long-term tradeoffs between
cesarean and vaginal delivery, as well
as the safe and appropriate
opportunities to prevent overuse of
cesarean delivery, particularly primary
cesarean delivery.

13. Indications for Primary Cesarean

14. Definition of Arrest of Labor
in the First Stage
Spontaneous labor: More than or
equal to 6 cm dilation with membrane
rupture and one of the following:
4 hours or more of adequate
contractions (eg, more than 200
Montevideo units)
6 hours or more of inadequate
contractions and no cervical change

15. Safe reduction of the rate of
primary cesarean deliveries (2014(
some intrapartum care practices
promote vaginal birth,
Continuous one-to-one support and
midwifery management are associated
with lower cesarean section rates.
. Strategies that can be implemented
in the current social and cultural
setting of obstetrics today are
recommended.

16. Maternal request
Public :
Health awareness ,education, media
involvement

17. Patient :
1- Benefits and risks of cs compared with vaginal
birth should be discussed and recorded.
2- A fear of childbirth :counseling (cognitive,
behavioral therapy for reduced fear of pain in
labour and shorter labour

18. Clinician
Has the right to decline a request for
CS in the absence of an identifiable
reason
The women decision
should be respected and she should be
offered referral for second opinion

19.  Continuous labor support, such as
labor doula care, reduces risk of
cesarean.
Cesarean is not appropriate even for
most babies that are estimated to be
large near the end of pregnancy
(estimates are often wrong, and
many large babies are born
vaginally).

20. If a baby is breech (buttocks- or
feet-first) at about 36 weeks of
pregnancy, hands-tobelly
movements to turn babies head-
first (“external cephalic version”)
should be offered.
 Women with twins and the first
twin head-first should be
encouraged to plan a vaginal birth.

21.  Women who are counseled about
avoiding excess pregnancy weight
gain may be able to avoid a
cesarean.
 Women who have had herpes
simplex virus. should plan a vaginal

22. Other ways to lower the chance of
having a cesarean
Research suggests that :
Having a care provider or group
and giving birth in a setting with
relatively low cesarean rates

23.  Women and care providers working together to delay
hospital admission until labor is well under way
 Using “intermittent auscultation” – periodic
listening with various devices – to monitor fetal heart
patterns rather than continuous electronic fetal
monitoring during labor
 Staying upright and moving around in labor before
the pushing phase, which is especially possible
without or before the use of epidural pain relief