Defensive caesarean section: A reality and a recommended health care improvement for Romanian obstetrics

Ionescu, Crîngu Antoniu; Dimitriu, Mihai; Poenaru, Elena; Banacu, Mihai; Furau, Gheorghe; Navolan, Dan; Pleș, Liana

doi:10.1111/jep.13025

Cited by 17 publications

(22 citation statements)

References 11 publications

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“…The risk aversion of doctors and a practice of defensive obstetrics has been documented in other studies [32]. The growing risk of violence for physicians at the hands of patients and their relatives is a growing phenomenon worldwide [33,34] and has been well documented in China [35,36]. The study agrees with many women and communities, health professional and health organization related factors identi ed by Betran et.al (2018) in their contribution to the Lancet series on CS [8].…”

supporting

confidence: 85%

Physician-Patient Communication in Decision-Making about Caesarean Sections in Eight District Hospitals in Bangladesh: A Mixed-Method Study

Doraiswamy

Billah

Karim

et al. 2020

Preprint

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Background: Caesarean sections (CS) in Bangladesh have risen eight-fold in the last 15 years. Few studies have explored why. Anecdotally, physicians suggest maternal request for CS is a reason. Women and families suggest physicians influence their decision-making. The aim of this research was to understand more about the decision-making process surrounding CS by exploring physician-patient communication leading to informed-consent for the operation. Methods: We conducted a mixed-method study using structured observations with the Option Grid Collaborative’s OPTION5 tool and interviews with physicians and women between July and December 2018. Study participants were recruited from eight district public-sector hospitals. Eligibility criteria for facilities was ≥80 births every month; and for physicians, was that they had performed CSs. Women aged ≥18 years, providing consent, and delivering at a facility were included in the observation component; primigravid women delivering by CS were selected for the in-depth interviews. Quantitative data from observations were analysed using descriptive statistics. Following transcription and translation, a preliminary coding framework was devised for the qualitative data analysis. We combined both inductive and deductive approaches in our thematic analysis. Results: In total, 306 labour situations were observed, and interviews were conducted with 16 physicians and 32 women who delivered by CS (16 emergency CS; 16 elective CS). In 92.5% of observations of physician-patient communication in the context of labour situations, the OPTION5 mean scores were low (5-25 out of 100) for presenting options, patient partnership, describing pros/cons, eliciting patient preferences and integrating patient preferences. Interviews found that non-clinical factors prime both physicians and patients in favour of CS prior to the clinical encounter in which the decision to perform a CS is documented. These interactions were both minimal in content and limited in purpose, with consent being an artefact of a process involving little communication.Conclusions: Insufficient communication between physicians and patients is one of many factors driving increasing rates of caesarean section in Bangladesh. While this single clinical encounter provides an opportunity for practice improvement, interventions are unlikley to impact rates of CS without simultaneoulsy addressing physician, patient and health system contextual factors too.

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supporting

confidence: 85%

Physician-Patient Communication in Decision-Making about Caesarean Sections in Eight District Hospitals in Bangladesh: A Mixed-Method Study

Doraiswamy

Billah

Karim

et al. 2020

Preprint

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“…The number of surgical interventions of all types has steadily increased worldwide, sometimes even alarming (e.g. caesarean section) [1][2][3][4][5].…”

Section: Abstract: Iodoform Triiodomethane Antiseptic Woundsmentioning

confidence: 99%

Iodoform (triiodomethane)- An Old, but Still Extremely Efficient Antiseptic

Dimitriu¹,

Socea²,

Ionescu³

et al. 2019

Rev. Chim.

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Iodoform (triiodomethane), a yellow crystalline solid, belonging to the family of organic halogen compounds, is used as an antiseptic. Its antiseptic action is due to the slow release of iodine under the action of catalase from wounds. Currently, it is widely used only in dentistry and in veterinary medicine. We have extended, with good results, the use of iodoform as an antiseptic for other types of surgical or traumatic wounds that have been infected with piogens. Between 2009 and 2018, on 242 cases of different wounds, we obtained good results, with no severe adverse effects.

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“…It is no longer a novelty that the cesarean section rate in Romania is among the top three in Europe and that it is among the top ranked in the world [1][2][3][4][5][6][7]. Some of the most recent statistical dates offered by World Health Organization (WHO) for Romania contained a caesarean rate of approximately 36% [1][2][3][4].…”

mentioning

confidence: 99%

“…As in many other parts of the globe, the causes of this high cesarean rate are not fully elucidated, but they appear to be the result of a variety of factors such as on demand cesarean and defensive cesarean, attributes of an obstetric medicine and medicine in an accelerated expansion after a long period of prohibitions [1][2][3][4].…”

mentioning

confidence: 99%

“…Another well-known fact is that countries do not constantly report data and that global reporting is not only discontinuous but also profoundly flawed by the absence of uniform reporting criteria to the WHO [1][2][3][4]. This makes it almost impossible to accurately and scientifically determine the causes and consequences of this variable percent of caesarean section [1], which is why there was more than a need for a language uniformization formula used by experts and professionals in the field, as well as uniformity of reporting rules.…”

mentioning

confidence: 99%

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Criteria for Cesarean Section-an Imperative and Emergent Necessity in Romanian Obstetrics

Dimitriu¹,

Socea²,

Pleș³

et al. 2019

Rev. Chim.

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The cesarean section rate in Romania is among the top three in Europe and that it is among the top ranked in the world. Robson classification is a particularly useful tool for all factors involved in obstetrics. In our study, 840 cesarean births from 2018 were classified according to Robson Classification. Thus, the patients analyzed in the present study have in common an almost obvious trait: the indication for caesarean is, in mostly analyzed cases, not very clear. In fact, much of the cesareans studied are nothing but cesarean performed at the request of the patient. We believe that the urgent implementation of Robson Classification in maternity hospitals in Romania is not only necessary, but also extremely urgent, being a practical tool in determining the causes of certain obstetrical practices and customs.

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Defensive caesarean section: A reality and a recommended health care improvement for Romanian obstetrics

Cited by 17 publications

References 11 publications

Physician-Patient Communication in Decision-Making about Caesarean Sections in Eight District Hospitals in Bangladesh: A Mixed-Method Study

Physician-Patient Communication in Decision-Making about Caesarean Sections in Eight District Hospitals in Bangladesh: A Mixed-Method Study

Iodoform (triiodomethane)- An Old, but Still Extremely Efficient Antiseptic

Criteria for Cesarean Section-an Imperative and Emergent Necessity in Romanian Obstetrics

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