Pattern of cesarean deliveries among women in an urban and rural district in Egypt

Aim: to compare patterns of delivery at an urban and a rural district in Egypt over 3 years. Methods: This retrospective study included 500 women and 50 obstetricians from each district from January, 2013 till December, 2015. Women answered a questionnaire about their deliveries. Obstetricians answered a questionnaire about their practiceof CS. Results: CS rate in the rural district was 57.2% compared to 54.8% in the urban district in 2013. In 2014 and 2015, CS rates increased to 65.3% and 69%, respectively in the rural district compared to 56% and 57.7%, respectively in the urban district. 66% of obstetricians in the rural district performed CS for more than 50% of their patients compared to 76% of obstetricians in the urban district. 52% and 4% of obstetricians in the rural and urban districts, respectively, performed CS upon maternal request. 70.3% of women in the rural district who delivered by CS preferred to deliver vaginally. 51.4% of urban women who delivered by CS preferred to deliver vaginally. Level of education was the only factor showing statistical significance. Conclusion: CS rates increased over time with higher rates in the rural area. Level of women's education was the only factor affecting delivery choice. Keywords: Cesarean sections; CS rate; urban area; rural area; Egypt; obstetricians

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely