Improving the Caesarean Decision by Robson Classification: A Population-Based Study by 5,323,500 Livebirth Data.

Background: Caesarean section is a major obstetric intervention for saving lives of women and their newborns from pregnancy- and childbirth-related complications. C-Section rate is considered an important indicator for measuring obstetric services in any country, region, or institution. In many countries, based on population, all-cause C-Section rates have increased steadily during the past half century. The high and rising C-Section rate is certainly a cause for concern, and evidence-based information is needed as to how or why the C-Section rate has increased and what needs to be done. In this study, we tried to demonstrate how the Robson Classification can be used as a common starting point to audit caesarean deliveries. Objectives: Given the lack of a scientifically proven classification system to observe and compare caesarean rates, the WHO proposes adopting the Robson's criteria-related grouping as an internationally applicable C-Section classification system. Methods: We conducted a retrospective study to look into the relation of Robson Criteria and C-Section. Our four years of study encompass 5,323,500 livebirths in Turkey and provide an important source of information for evaluating statistical data. Findings: We analysed pregnancies according to the percentage of live births in Robson's groups and the caesarean rate within the Robson's groups. In total, 2,764,373 pregnant women have undergone caesarean over 4 years with a 51.9% C-Section rate. According to our findings, as time progresses, the R5 group are expanding due to the caesarean sections groups R1-R4.The R5 group C-Section rate increased regularly from 22.2% in 2013 to 24.3% in 2016. Caesarean sections performed in R1-R4 groups cause subsequent pregnancies of these women to result in caesarean section. Conclusions: Our results suggest the Robson classification system will help in analysing, screening, auditing, and comparing caesarean rates across different hospitals, countries, or regions and will help to create and implement effective strategies specifically to reach WHO recommended C-Section rates.

Educate, Re-educate, Then Re-educate: Organ Donation-centered Attitudes Should Be Established in Society.

OBJECTIVE: The objectives of the study are to evaluate knowledge and attitudes toward organ and tissue donation, to pursue a deeper understanding of attitudes toward organ donation, and to gain an understanding of the underlying, personal reasoning for the desired action in organ donation among the adult population. METHODS: Four thousand people were interviewed who were selected by the simple random sample type. A survey was conducted by voluntary, face-to-face interviews using a printed 25-item questionnaire form presented to street-recruited individuals over 18 years of age. RESULTS: In the study, where male/female distribution was represented equally, the majority of participants consisted of young and middle-aged, primary school graduates between the ages of 25 to 44 years. Although 91.1% of the respondents stated that they support organ donation, only 75.3% stated they wanted to donate organs. Organ donation-centeredness rates were low in those who did not finish a primary school education, people with a low household income, and those ≥65 years age group. A majority of the respondents (91.2%) were found to be against financial incentives for organ donation. Although 91.4% of the participants stated that organ donation is important if the recipient is a relative, this ratio decreased to 86.7% for a nonrelative. In our study, the level of accepting an organ as a recipient from an unknown person was 9.1% higher than the rate of willingness to donate to an unknown person. Surprisingly, despite 84% saying their religion is not against organ donation, 38.4% of the respondents cited religious concerns as the main reason for unwillingness and 58% of them indicated that they were reluctant to donate organs due to religious beliefs. CONCLUSIONS: It is important to know that it is not certain that anyone who is hypothetically in favor of organ donation will donate when faced with a real choice. Increasing the number of donors is the most important issue in order to benefit more patients in transplantation, which has achieved a very important success level through serious efforts. The majority of Turkey's population know about organ donation, support transplantation, and would be willing to donate their organs. Most of the respondents find it religiously correct and believe that it is an acceptable lifesaving procedure. However, a high percentage did not know how to donate, and they indicated that the information available on the subject is insufficient. Mass media campaigns and educational activities could resolve this matter and increase organ donation. According to the results of our study, when considering the number of patients who died while waiting for transplantation, organ donation awareness projects that are focused on converting knowledge to behavior are believed to be very critical. It is important to provide organ donation-oriented training at every educational level.