Practice of Assisted Vaginal Birth in Egypt

Official title

Factors Affecting the Practice of Assisted Vaginal Birth in Three Tertiary Level Hospitals in Egypt. A Cross-Sectional Study

Overview

In Egypt, the proportion of CSs has been steadily increasing in recent years and has reached an alarming level. According to data from the Royal College of Obstetricians and Gynaecologists (RCOG), approximately 6% of caesarean sections (CS) are performed on average because of inadequate supervision from junior staff members or a lack of training, particularly during the critical decision-making phase of this second stage. The unfamiliarity and lack of experience with operative vaginal delivery is a major cause for the rise in the rate of second stage caesarean section. This survey targets obstetricians with different levels of experience to find practical solutions to increase the rate of assisted vaginal delivery which subsequently will decrease the rate of second stage CS.

Detailed description

Egypt is a populous African country with a population of about 102 million people in 2020. Egypt has the highest cesarean section (CS) rate in the Middle East, which has increased from 20% in 2005 to 52% in 2014. Globally, the estimated number of births by Cesarean section (CS) increased from 16 million (12%) in 2000 to 29.1 million (21%) in 2015. Furthermore, during the same period, several studies have demonstrated a remarkable increase in the rate of second-stage cesarean section.

Whereas forceps-assisted vaginal delivery represented 38% of deliveries in rural areas of Egypt, in the United States, operative vaginal delivery in the form of either forceps-assisted vaginal delivery (FAVD) or ventouse-assisted vaginal delivery (VAVD) has declined remarkably since 1990. The utilization of operative vaginal delivery in live births decreased from 9.0% in 1990 to 3.1% in 2016. During the same period, the percentage of VAVD deliveries fell from 3.9 to 2.6%, and FAVD from 5.1 to just 0.5%. The declining rate of assisted vaginal delivery contributed to the rise in the cesarean section rate from 22.7% in 1990 to 31.9% in 2016.

The performance of AVB by physicians with a high level of experience and certified training courses should be considered a safe alternative to second-stage cesarean section. This does not only depend on the physician, but it also depends on the patient's preference. In this survey, the investigators explore Egyptian obstetricians 'attitudes and perceptions on AVB.

Interventions

• Other Survey using a questionnaire.
  This cross-sectional study aims to identify the obstacles preventing an increase in AVB performance in Egypt. Obstetricians from three tertiary care centers in Egypt will be invited to participate in this Online web-based survey over the study period. The questions in this survey are included in 5 sections; demographics, workload and AVB practice, obstetrician-related factors, service provision factors, and what changes could be implemented to increase the rate of uptake of AVB by Egyptian obste

Primary outcome measures

• Obstacles preventing the increase in the performance of assisted vaginal birth in Egypt by a questionnaire directed to obstetricians in three maternity tertiary centers in Cairo, Egypt [Time frame: through the study completion, an average of 4 months]

Eligibility criteria

Inclusion criteria

• Obstetricians with at least 3 years of experience in practicing obstetrics
• Obstetricians with their primary health care facility being one of the three Tertiary centres, Ain Shams University Maternity Hospital, El Hussein University Hospital, and El Kasr Alaini Hospital

Exclusion criteria

\-

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Observational model

Other

Study locations

Egypt · 1 center

• Ainshams University maternity hospital — Cairo

Publications

• Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery. Obstet Gynecol. 2014 Mar;123(3):693-711. doi: 10.1097/01.AOG.0000444441.04111.1d. PMID 24553167
• Becker DA, Blanchard CT, Szychowski JM, Rogers SL, Brumfield CG, Subramaniam A. Resident Operative Vaginal Delivery Volume after Educational Curriculum Implementation. Am J Perinatol. 2020 Nov;37(13):1296-1300. doi: 10.1055/s-0040-1710543. Epub 2020 May 26. PMID 32455468
• Darmstadt GL, Hussein MH, Winch PJ, Haws RA, Gipson R, Santosham M. Practices of rural Egyptian birth attendants during the antenatal, intrapartum and early neonatal periods. J Health Popul Nutr. 2008 Mar;26(1):36-45. PMID 18637526
• Banerjee A, Al-Dabbach Z, Bredaki FE, Casagrandi D, Tetteh A, Greenwold N, Ivan M, Jurkovic D, David AL, Napolitano R. Reproducibility of assessment of full-dilatation Cesarean section scar in women undergoing second-trimester screening for preterm birth. Ultrasound Obstet Gynecol. 2022 Sep;60(3):396-403. doi: 10.1002/uog.26027. PMID 35809243
• Jadoon B, Assar TM, Nucier AAAR, Raziq HEA, Abd El-Azym Saad AS, Megahed Amer W. Analysis of the caesarean section rate using the 10-Group Robson classification at Benha University Hospital, Egypt. Women Birth. 2020 Mar;33(2):e105-e110. doi: 10.1016/j.wombi.2019.03.009. Epub 2019 Apr 13. PMID 30987799
• Fasseeh A, ElEzbawy B, Adly W, ElShahawy R, George M, Abaza S, ElShalakani A, Kalo Z. Healthcare financing in Egypt: a systematic literature review. J Egypt Public Health Assoc. 2022 Jan 7;97(1):1. doi: 10.1186/s42506-021-00089-8. PMID 34994859

Identifiers

NCT: NCT07308977 · 20

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗