Exploring obstetrical interventions and stratified cesarean section rates using the Robson classification in tertiary Care hospitals in the united arab emirates

Abstract Objective The objective of the present study was to explore obstetric management in relation to clinical, maternal and child health outcomes by using the Robson classification system. Methods Data was collected from obstetrics registries in tertiary care hospitals in Dubai, United Arab Emirates (UAE). Results The analysis of > 5,400 deliveries (60% of all the deliveries in 2016) in major maternity hospitals in Dubai showed that groups 5, 8 and 9 of Robson's classification were the largest contributors to the overall cesarean section (CS) rate and accounted for 30% of the total CS rate. The results indicate that labor was spontaneous in 2,221 (45%) of the women and was augmented or induced in almost 1,634 cases (33%). The birth indication rate was of 64% for normal vaginal delivery, of 24% for emergency CS, and of 9% for elective CS.The rate of vaginal birth after cesarean was 261(6%), the rate of external cephalic version was 28 (0.7%), and the rate of induction was 1,168 (21.4%). The prevalence of the overall Cesarean section was 33%; with majority (53.5%) of it being repeated Cesarean section. Conclusion The CS rate in the United Arab Emirates (UAE) is higher than the global average rate and than the average rate in Asia, which highlights the need for more education of pregnant women and of their physicians in order to promote vaginal birth. A proper planning is needed to reduce the number of CSs in nulliparous women in order to prevent repeated CSs in the future. Monitoring both CS rates and outcomes is essential to ensure that policies, practices, and actions for the optimization of the utilization of CS lead to improved maternal and infant outcomes.

Factors influencing colostrum yield by sows / Fatores que influenciam a produção de colostro em porcas

An adequate colostrum intake, in order to ensure the survival and weight gain of piglets, depends on the sow's ability to produce enough colostrum for the whole litter. The aim of this study was to evaluate factors involved in colostrum yield (CY) variability related to the sow, the litter and the farrowing process. The experiment was conducted with 96 Camborough 25(r) sows of parities one to seven, whose farrowing was spontaneous. Colostrum production of each sow was estimated by summing up the colostrum intake of each piglet in the litter, estimated by an equation that takes into account the birth weight and weight gain during the first 24h of life. The multiple regression model explained 28% of variation in CY, with 24% and 4% respectively of variation being explained by the litter birth weight and the width of the first mammary glands. Litter birth weight was positively correlated with the number of total born (r= 0.73) and born alive piglets (r= 0.83). When categorised into two groups of colostrum yield (LOWCY; ≤3.4kg; n= 46 vs HIGHCY; >3.4kg; n= 50), LOWCY sows had fewer total born and born alive piglets and lighter litters (P<0.05). The logistic regression analysis showed that sows from parities 1, 2 and >3 had greater odds (P≤0.05) of belonging to the LOWCY group than parity 3 sows. Sows with two or more obstetrical interventions had higher odds (P<0.05) of belonging to the LOWCY group than sows without interventions during farrowing. The higher colostrum yield observed in sows of parity 3 and sows with less than two obstetrical interventions during farrowing was associated with a greater number of nursed piglets. This study showed that total birth weight of born alive piglets is the most important factor involved in colostrum yield variability, indirectly representing the number of piglets nursed by the sow.(AU)

Um consumo adequado de colostro, para assegurar a sobrevivência e o ganho de peso, dos leitões, depende da capacidade da porca em produzir colostro suficiente para toda a leitegada. O objetivo deste estudo foi determinar fatores relacionados com a porca, com a leitegada ou com o parto que possam influenciar a produção de colostro (PC). O experimento foi conduzido com 96 porcas Camborough 25, de ordem de parto (OP) 1 a 7, cujo parto foi espontâneo. A produção de colostro das porcas foi estimada pela soma do consumo individual de colostro pelos leitões, o qual foi estimado por equação que considera o peso ao nascimento e o ganho de peso nas primeiras 24h de vida. Por meio de modelo de regressão múltipla, 28% da variação na PC foi explicada pelo peso da leitegada (24%) e pela largura do primeiro par de glândulas mamárias (4%). O peso da leitegada foi positivamente correlacionado com o número total de leitões nascidos (r= 0.73) e com o número de leitões nascidos vivos (r= 0.83). Quando separadas em dois grupos de PC (BAIXAPC; ≤3.4kg; n=46 e ALTAPC; >3.4kg; n=50), as porcas do grupo BAIXAPC tiveram menor número total de leitões nascidos, menor número de leitões nascidos vivos e leitegadas mais leves (P<0.05). Por regressão logística, foi observado que porcas da OP 1, 2 e >3 tiveram maior chance (P≤0.05) de pertencer ao grupo BAIXAPC do que porcas de OP 3. Porcas com duas ou mais intervenções obstétricas tiveram maior chance (P<0.05) de pertencer ao grupo BAIXAPC do que as porcas sem intervenção durante o parto. A maior PC observada nas porcas de OP 3 e nas porcas com menos intervenções obstétricas foi associada com um maior número de leitões amamentados. Foi mostrado, neste estudo, que o peso total da leitegada viva, o qual indiretamente representa o número de leitões amamentados pela porca, é o fator mais importante envolvido na produção de colostro.(AU)