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Re: Pelvic organ prolapse and incontinence 15–23 years after first delivery: a cross‐sectional study
Author(s) -
Georgiou Christiana,
Raja Malar,
Ye Weiyu,
Grosu Liliana,
Jaffar Hamna,
Neale Ed,
Mahran Montasser
Publication year - 2015
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.13587
Subject(s) - obstetrics and gynaecology , medicine , general hospital , gynecology , university hospital , obstetrics , general surgery , family medicine , pregnancy , genetics , biology
bution of each group to the overall CS rate. As stated in the recent World Health Organization statement, which recommends the use of TGCS at the local level, ‘this classification can help health care facilities to optimise the use of caesarean section by identifying, analysing and focusing interventions on specific groups of particular relevance for each health care facility”. In our centre, as also reported in our national study and in most studies using TGCS in developed countries, the focus should be on group 1 (Nulliparous with single cephalic pregnancy, ≥37 weeks of gestation in spontaneous labour), group 2 (Nulliparous with single cephalic pregnancy, ≥37 weeks of gestation who either had labour induced or were delivered by CS section before labour) and group 5 (All multiparous with at least one previous uterine scar, with single cephalic pregnancy, ≥37 weeks of gestation). We are convinced that the assessment of the CS rate using TGCS should be continuous and performed every year, to be effective. However, to take into account population changes over time, adjustment on maternal characteristics (especially maternal age and body mass index) as performed in our paper, is needed when possible. Finally, we agree that audits of CS should be conducted, in addition to the analysis with the TGCS. This can be performed, as described by Nair et al. in their letter, only for deliveries by CS in the Robson subgroups identified or for all CS. In our centre, we review all caesarean deliveries performed over the last 24 hours at a daily meeting with all the medical staff. We also perform a weekly meeting to prospectively check the indications of planned CS to avoid the medically unjustified ones. These two types of clinical audit are complementary. Clinical audit of CS indications seems indeed an effective intervention to decrease rate of CS without adverse effects on maternal and neonatal outcomes as demonstrated by a recent multifaceted trial conducted in Quebec.&