The comparison of the delivery rate for the year of 2004 and 2007 in the town of Ağrı

Objective

We objective to review our clinic registrations retrospectively and to show the patients who delivered by normal spontaneus vaginal and the patients who delivered by cesarean according to demographic specialities and the endications to the years.

Methods

The birth registrations 2004 and 2007 years of Ağrı Maternity and Children Hospital are retrospectively reviewed and is surveilled for the patients who delivered age, gravida, parity and cesarean indications to the years.

Results

In the 2004 years total 3593 patients had normal spontaneus vaginal delivery and 335 patients had cesarean sections. İn the 2007 years 4439 years had normal spontaneus vaginal delivery and 658 patients had cesarean section.

Conclusion

Tthe cesarean section ratio of our clinic showed that there is an increase in numbers and ratios as like as other Turkish hospitals and worldwide.

Keywords

Cesarean, normal spontaneus vaginal delivery, endication

Introduction

The cesarean operation is the fetuses of more than 500 grams delivered by the abdominal route by incising abdominal front wall and uterus.(1)Cesarean operation is an alternative birth method which vaginal birth is not possible or vaginal birth has risk for the fetus.İn the recent years in whole developed countries the ratios of cesarean operation are continuously increased.(2)Most important causes of the progressive increase are the confidence of the classic cesarean technic,development of the anesthesia methods,easiness to get blood products and expanding ofthe operation endications.(3)
At the beginning of the 1970 and 1980 years cesarean birth ratios are progressively increased in the whole world.(4)Cause of the increasing ratios is known multifactorial.İncrease of the woman had cesarean,increase of the assistant reproductive technics and increase of multiple pregnancy,widely used intrapartum fetal monitoring and increase of the legal and ethnic responsibilities are causes.(5)When you looking at America and European Countries,especially in 1970’s the cesarean birth ratios was low but this progressively increased and reach peak level in the 2000’s years.(6)Wide patient population studies in the literature are examined and thecauses of cesarean births are distocia,the suspect of the threatening fetal health,malpresentation and the previous cesarean birth.Whenthese causes are examined,cesarean birth ratios fort he previous cesarean birth %26.1;distocia %22,malpresentation %11.7;fetal distress %10.7;other endications(placental disturbances,multiple pregnancy,fetal diseases,maternal psychologic events)%28.5 (7).The aim of our study is to examine of our clinic2004-2007 years normal birth and cesarean birth ratios and endications.

Methods

In our sudy the patients who delivered in Ağrı Maternity Hospital between 2004-2007 years examined retrospectively according to demographic charactheristics,gravida and parity,birth weeks,cesarean endications,birth weights,neonatal sex.Maternal age,parity,gestational age,birth weight and neonatal sex are detected by file registers of patients.Cesarean ratios and cesarean endications are detected simultaneously according to the years.Our study datas are analysed by SPSS 13.0 statistics program.

Results

9025 patients who are delivered in the Ağrı Maternity Hospital between 2004-2007 years are included our study.Among these patients 8032 patients had normal spontan vaginal delivery,933 patients had cesarean delivery.İn 2004 years,3593 patients had normal spontan vaginal delivery,335 patients had cesarean delivery and in 2007 years 4439 patients had normal spontan vaginal,658 patients had cesarean delivery.These datas are summarized in table 1.
The patients who delivered between 2004-2007 years are examined according to demographic charactheristics;average age of the patients was 22.26 +/-4.6,the youngest patient 18 and the oldest one was 44 years.The lowest birth weight was 2620g,the highest birth weight was 4440g and average neonatal weight was 3154 +/-232.7g,average gravida of the patients were 1.74 +/-0.61,average parity was 1.43 +/- 0.61.Cesarean statistics are examined according to years;in the 2004 years 335(%9)patients,in the 2007 years 658(%14)patients had cesarean delivery.When the cesarean endications are examined in the 2004 years 268 patients had for the repeated cesarean(%80),14 patients breech presentation(%4),8 patients cephalopelvic disproprtion(%2),8 patients fetal distress(%2) and other patients for the other causes(ablatio placenta,arm presentation,cord prolapsus,elective,facial presentation,situs transversus).İn the 2007 years 341 patients repeated cesarean(%51),75 patients breech presentation(%11),67 patients cephalopelvic disproportion(%10),20 patients fetal distress(%8) and other patients for the other causes(ablatio placenta,arm presentation,cord prolapsus,elective,facial presentation,situs transversus) hadcesarean operation.these datas are summarized in table 2.

Discussion

Cesarean sectio is one of the most often procedure in the maternity services.By the abdominal uterin incision,delivering of thedead or live fetus is called cesarean which is one of the most performing operations in USA.(8)Like Europe and USA in our country cesarean birth ratios are increased.According to Yumru and colleaques’s study in our country at the educational hospitals for five years period cesarean ratios are %100 increased.(9)When the retrospective studies in our country are examined especially in the third class therapy centers cesarean ratios raise %40,when the same studies are examined cesarean ratios change %15-35.(10,11,12)Güney and colleaques study showed that cesarean sectio ratios of the third level center for the five years period raised to %85.(2)
Among the cesarean endications,the most known causes are distocia,fetal distress,malpresentation and previous cesarean births.Meanwhile patient type and abilities,individual medical talents,health insurance and the women’s thinks about birth type and legal medical effects are influence cesarean sectio ratios.(13)Especially in the developed countries high maternal age is a factor that increase the insidance of the cesarean births.The epidural anesthesia which used normal spontan vaginal deliveries extends the second phase of the birth and increase of the cesarean birth insidance.(14)Like our country,Europe and USA stated increased cesarean ratios according the years.At the beginning of the 1984 yearsit is stated that in USA cesarean ratios were %21(15).İn the 2001 years cesarean ratios are increased to %24.(16)İn the European Countries the cesarean ratios are changed and increased according tothe years.Cesarean insidance was %2.5 in 1972,at the beginning of the 2000 years the insidance is increased to %21.3(17)İn our study the cesarean insidance is increased according to the years,too.
Prefering nonmedical cesarean,think of the doctor or patient which vaginal delivery insults pelvic floor and the think of the doctor which the cesarean birth according to the vaginal birth causes leaser fetal and maternal morbidity.More dramatically and tobe accepted a malpractice;economic thinks,taking more time of the normal delivery according to the cesarean,doctor’s think of the defense to the complications of the normal vaginal delivery by the cesarean birth.The most often cesarean endication in the literature is old (underwent)cesarean and pelvic distocia,fetal distress and breech presentation follow this.(18)İn our study repeated cesarean ratio is %89 in 2004,in 2007 this ratio is accepted %64.The decrease of the repeated cesarean ratio isn’t accepted true,because there is an increase old cesarean number,meanwhile there is an increase common patient number. Maternal and perinatal mortality and morbidity is higher than adult pregnancies in adolescent pregnancies.Pregnancy induced hypertension,gaining insufficient weight in pregnancy,anemi,placenta previa,ablatio placenta,operative vaginal delivery,cesarean birth,abortus,preterm birth and afetus with low birth weight is more often in this pregnancies.(19,20)These age group of pregnancies which accept high risk are present high ratios and this status can be increase maternal and perinatal complication ratios in our territory.

Conclusion

Consequencely,in the provinces lıke Ağrı with birth rates are high and socioeconomic status is low,giving the family planning and birth control method service is healthier,encouraging of adolescent pregnants for the normal birth,insurance foundations,university hospitals and other health institutions making the legal regulations which diminish cesarean ratios and increase vaginal birth ratios,reduce the cesarean ratios and raise the normal birth ratios in our province and like the other provinces which has similar status.

References

1) Amirikia H, Zarewych , Evans TN.Cesarean section: a 15- year review of changing incidence, indications and risks.Am J Obstet Gynecol 1981;140:81-90.
2) Güney M, Uzun E, Oral B, Sarıkan İ, Bayhan G, Mungan .Kliniğimizde 2001-2005 yılları arasında sezaryen oranı ve endikasyonları.TJOD 2006; 3:4, 249-254.
3) Paterson-Brown S, Fisk NM.Caeserean section: Every woman’s right to choose? .Curr Opin Obstet Gynecol 1997; 9: 351-355. .
 4) Kiran UTS, Jayawickrama NS.Who is responsible for the rising cesarean section rate? .J Obstet Gynecol 2002; 22: 363-365.
5) Gamble JA, Creedy DK.Women’s request for a cesarean section: A critique of the literature.Birth 2000; 27: 256-263. . 6) Treffers PE, Pel M.The rising trend for caesarean section rate.BMJ 1993, 307: 1017-1018.
 7) Anderson GM, Lomas J.Determinants of the increasing cesarean birth rate. Ontario data 1979 to 1982. N Eng J Med 1984; 311: 887-892.
 8) Gabert HA, Bey M.History and development of cesarean operation.Obstet Gynecol Clin North Am 1998; 15:591-598. . 9) Yumru E, Davas İ, Baksu B, Altıntaş A, Altın A, Mert M.1995-1999 yılları arasında Sezaryen operasyonları endikasyonları ve oranları. .Perinatoloji Dergisi 2000; 8: 94-98..
 10) Karaosmanoğlu S, İnan A, Baysal C, Görgen H.Yükselen Sezaryen oranları ve olgularımız.Zeynep Kamil Tıp Bülteni 1990; 607-613.
 11) Önderoğlu L, Deren Ö, Ayhan A, Gürgan T.Vaginal doğum mu? Sezaryen mi? .Hacettepe Tıp Dergisi 1999; 30: 61-65..
12) Bayhan G, Yalınkaya A, Yayla M, Yalınkaya Ö, Erden AC.Kliniğimizde 1995-1999 Yılları arasında yapılan sezaryenlerin ve sezaryen esnasında yapılan diğer Operasyonların değerlendirilmesi.Medikal Network Klinik Bilimler ve Doktor Dergisi 2000;6:249-251.
13) Quinlivan JA, Petersen RW, Nichols CN.Patient preference the leading inidication for elective cesarean section in public patients-Results of 2- year prospective audit in a teaching hospital. .Aust NZ J Obstet Gynaecol 1999, 39: 207-214. 14) Patel RR, Peters TJ, Murphy DJ.Prenatal risk factors for Caesarean section. Analyses of the ALSPAC cohort of 12 944 women in England.Int J Epid 2005; 34: 353-367. .
 15) Rutkow IM.Obstetrics and Gynecologic operation in the United States, 1979 and 1984.Obstet Gynecol 1986; 67: 755-759.
16) Martin JA, Hamilton BF, Ventura SJ et al.Births: Final data for 2001. Natl Vital Stat Rep 2002; 51: 1-102.
17) Kolas T, Hofoss D, Daltveit AK, et al.Indications of cesarean deliveries. .Am J Obstet Gynecol 2003; 188: 864-870. . 18) Mutryn CS.Psychosocial impact of caesarean section on the family: A literature review. Soc Sci Med 1999; 37: 1271- 1281..
19) Scholl TO, Hediger ML,Belsky DH.Prenatal care and maternal health during adolescent pregnancy: a review and meta-analyses. .J Adolesc Health 1994; 15: 444-449.
20) Hediger ML, Scholl TO, Schall JI, et al.Young maternal age and preterm labor.Ann Epidemiol 1997; 7: 400-412..

	File/Dsecription
	Tablo 1. Distribution to normal spontaneus vaginal deliveries and cesarean deliveries for years.
	Tablo 2. Distribution to cesarean endication.