AJOG Global Reports (Feb 2024)

The use of bubble charts in analyzing the global second-stage cesarean delivery rates: a systematic reviewAJOG Global Reports at a Glance

  • Lin Tai Linus Lee, MRCOG,
  • Christopher Pak Hey Chiu, MRCOG,
  • Man Kee Teresa Ma, MRCOG,
  • Lee Ting Kwong, MRCOG,
  • Man Wai Catherine Hung, MRCOG,
  • Yuen Yee Yannie Chan, MRCOG,
  • Eunice Joanna Wong, MBBS,
  • Theodora Hei Tung Lai, MRCOG,
  • Oi Ka Chan, MSc,
  • Po Lam So, MMedSc,
  • Wai Lam Lau, FRCOG,
  • Tak Yeung Leung, MD

Journal volume & issue
Vol. 4, no. 1
p. 100312

Abstract

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OBJECTIVE: This study aimed to systematically review the worldwide second-stage cesarean delivery rate concerning pre–second-stage cesarean delivery and assisted vaginal birth rates. DATA SOURCES: PubMed, Medline Ovid, EBSCOhost, Embase, Scopus, and Google Scholar were queried from inception to February 2023, with the following terms: “full dilatation,” “second stage,” and “cesarean,” with their word variations. Furthermore, an additional cohort of 353,434 cases from our recently published study was included. STUDY ELIGIBILITY CRITERIA: Only original studies that provided sufficient information on the number of pre–second-stage cesarean deliveries, second-stage cesarean deliveries, and vaginal births were included for the calculation of different modes of delivery. Systemic reviews, meta-analyses, or case reports were excluded. METHODS: Study identification and data extraction were independently performed by 2 authors. Selected studies were categorized on the basis of parity, study period, and geographic regions for comparison. RESULTS: A total of 25 studies were included. The overall pre–second-stage cesarean delivery rate, the second-stage cesarean delivery rate, and the second-stage cesarean delivery–to–assisted vaginal birth ratio were 17.94%, 2.65%, and 0.19, respectively. Only 5 studies described singleton, term, cephalic presenting pregnancies of nulliparous women, and their second-stage cesarean delivery rates were significantly higher than those studies with cohorts of all parity groups (4.50% vs 0.83%; P<.05). In addition, the second-stage cesarean delivery rate showed a secular increase across 2009 (0.70% vs 1.05%; P<.05). Moreover, it was the highest among African studies (5.14%) but the lowest among studies from East Asia and South Asia (0.94%). The distributions of second-stage cesarean delivery rates of individual studies and subgroups were shown with that of pre–second-stage cesarean delivery and assisted vaginal birth using the bubble chart. CONCLUSION: The overall worldwide pre–second-stage cesarean delivery rate was 17.94%, the second-stage cesarean delivery rate was 2.65%, and the second-stage cesarean delivery–to–assisted vaginal birth ratio was 0.19. The African studies had the highest second-stage cesarean delivery rate (5.14%) and second-stage cesarean delivery–to–assisted vaginal birth ratio (1.88), whereas the studies from East Asia and South Asia were opposite (0.94% and 0.11, respectively).

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