STRATEGIES FOR RATIONALISING/REDUCING CAESAREAN SECTION RATE BY USE OF "SION MODEL".pptx
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The document discusses the rising rates of cesarean deliveries in India and introduces the 'Sion Model,' developed by Dr. Niranjan Chavan, which aims to reduce unnecessary C-sections by promoting evidence-based practices and patient-centered care. It highlights the importance of teamwork among healthcare providers and outlines the model's methodology, including labor induction techniques that have shown increased success rates for vaginal deliveries. The ultimate goal of the Sion Model is to enhance maternal health outcomes and improve communication and satisfaction for expectant mothers.
STRATEGIES FOR RATIONALISING/REDUCING CAESAREAN SECTION RATE BY USE OF "SION MODEL".pptx
- 1. STRATEGIES FOR RATIONALISING/ REDUCING CAESAREAN SECTION RATE BY USE OF “SION MODEL” FOGSI PRESIDENTIAL CONFERENCE 7th JULY 2024
- 3. DR. NIRANJAN CHAVAN MD, FCPS, DGO, MICOG, DICOG, FICOG, DFP, DIPLOMA IN ENDOSCOPY (USA) Professor and Unit Chief, L.T.M.M.C & L.T.M.G.H, Sion Hospital President, MOGS (2022-2023) Joint Treasurer, FOGSI (2021-2025) Organising Secretary, AICOG Mumbai 2025 Treasurer, AFG (2023-2024) Member Oncology Committee, SAFOG (2021-2023) Dean AGOG & Chief Content Director, HIGHGRAD & FEMAS Courses Editor-in-Chief, FEMAS, JGOG & TOA Journal 87 publications in International and National Journals with 198 Citations National Coordinator, FOGSI Medical Disorders in Pregnancy Committee (2019-2022) Chair & Convener, FOGSI Cell Violence Against Doctors (2015-16) Member, Oncology Committee AOFOG (2013-2015) Coordinator of 11 batches of MUHS recognized Certificate Course of B.I.M.I.E at L.T.M.G.H (2010-16) Member, Managing Committee IAGE (2013-17), (2018-20), (2022-2023) Editorial Board, European Journal of Gynaec. Oncology (Italy) Course Coordinator of 3 batches of Advanced Minimal Access Gynaec Surgery (AMAS) at LTMGH (20 2018-19) 18-19)
- 4. The percentage of caesarean deliveries across India increased from 17.2 to 21.5% between NFHS-4 (2015-16) and NFHS-5 (2019-21). All but four states and union territories in India experienced an increase in caesarean delivery rates over the 5 years studied.
- 5. Reasons for the Rise in C-Section Cases Despite a decrease in pregnancy complications, the number of C-section cases has risen significantly in recent years, from 17.2% to 21.5% over a five-year period. This trend can be attributed to factors such as maternal age, underlying health conditions, and the preference for a more controlled birthing experience.
- 6. Risks and Complications of C- Sections and its Recovery While C-sections are generally safe, they do carry certain risks and potential complications for the mother and baby. These include infection, bleeding, blood clots, and breathing difficulties for the infant. Recovering from a C-section can take several weeks. Patients typically stay in the hospital for 4-5 days after the procedure, with a gradual return to normal activities over the following 4-6 weeks
- 7. Choosing Between C - Section & Vaginal Delivery • The decision to have a C-section or attempt a vaginal delivery is highly personal and depends on a variety of factors. • Factors like the mother's health, the baby's position, and potential complications can all influence the best delivery method. • In some cases, a C-section may be planned and scheduled in advance rather than performed as an emergency procedure. • Certain medical conditions or complications may indicate that a scheduled C-section is the safest delivery option for the mother and baby.
- 8. LTMGH & LTMMC, famously known as Sion Hospital was established in 1947. It is a renowned multi-specialty healthcare institution in Mumbai, India. From its humble beginnings with just 10 beds, it has grown into a sprawling campus with over 1,400 beds, offering a wide range of medical services to the community.
- 9. Humble Beginnings in 1947 1 1947 Sion Hospital was founded with just 10 beds, serving the local community in its early days. 2 1960s The hospital gradually expanded its services and patient capacity to meet the growing healthcare needs of the region. 3 Today Sion Hospital has evolved into a multi-specialty healthcare hub with over 1,400 beds and state-of-the- art facilities.
- 10. Lokmanya Tilak Municipal Medical College (LTMMC) Medical Education Hub Sion Hospital is attached to the Lokmanya Tilak Municipal Medical College (LTMMC), a prestigious teaching institute for medical sciences. Undergraduate and Postgraduate Programs LTMMC offers comprehensive medical education, including undergraduate and postgraduate programs, to train the next generation of healthcare professionals. Collaborative Efforts The close partnership between Sion Hospital and LTMMC allows for seamless integration of patient care, medical education, and research. Advancing Medical Knowledge Through this collaboration, Sion Hospital and LTMMC are at the forefront of medical advancements, contributing to the field of healthcare.
- 11. Unique Location and Role Emergency Hub Sion Hospital's strategic location near major highways allows it to respond quickly to emergency situations and cater to the needs of nearby communities. Referral Center As a leading healthcare institution, Sion Hospital serves as a major referral center, attracting patients from across the region who require specialized care. Community Outreach The hospital actively engages with the local community, offering healthcare services, education, and community- based initiatives to improve overall well-being.
- 12. Sion Hospital Dr. NNC Unit: Dept. of Ob & Gyn. Located in the heart of Dharavi, Asia's largest slum, Sion Hospital's Department of Obstetrics and Gynecology provides essential care and support to expectant mothers from Mumbai, Maharashtra, and across India.
- 13. Dedicated Units 6 Specialized Units The department is divided into six specialized units, each focused on specific aspects of obstetrics and gynecology. Dr. N. N. Chavan Unit One of the six units, named after a renowned obstetrician, providing exceptional care to patients. Extensive Expertise The dedicated teams in each unit bring a wealth of experience and knowledge to their respective fields. Collaborative Approach The units work closely together to deliver comprehensive and coordinated care to their patients.
- 14. Delivering Hope Deliveries Approximately 1,500 to 1,700 deliveries are performed annually by the skilled medical team. Maternal Care Comprehensive prenatal, delivery, and postnatal care ensure the well-being of mothers and their newborns. Community Impact The department's dedicated service has made a significant difference in the lives of families in the surrounding areas.
- 15. Specialized Expertise Prenatal Care Delivery Services Postnatal Support Gynecological Care Regular checkups Routine and high-risk deliveries Dedicated postpartum care Treatment for women's health issues Monitoring and consultations/ M - Mitra Skilled obstetricians Guidance for new mothers Comprehensive services
- 16. Introduction to the "Sion Model" The "Sion Model," was developed by Prof. Dr Niranjan Chavan in June 2023.
- 17. Implementation of “Sion Model” The Sion Model is a comprehensive approach to improving maternal health outcomes. It prioritizes evidence-based practices and emphasizes the importance of teamwork, communication, and patient-centered care.
- 18. Alignment with CMQCC Toolkit Recommendations Evidence-Based Practices The Sion Model incorporates key recommendations from the CMQCC Toolkit, such as promoting vaginal birth and reducing unnecessary cesarean sections. Multidisciplinary Approach It emphasizes the importance of collaboration among healthcare providers, including obstetricians, nurses, midwives, and other specialists. Patient Education and Empowerment The Sion Model empowers patients by providing them with the information and support they need to make informed decisions about their care.
- 19. Key Features and Benefits of the Sion Model 1 Improved Maternal Health Outcomes By promoting vaginal birth and reducing cesarean sections, the Sion Model can lead to fewer complications and a faster recovery for mothers. 2 Enhanced Patient Satisfaction The patient-centered approach of the Sion Model promotes better communication and understanding, leading to increased patient satisfaction. 3 Reduced Healthcare Costs By reducing the need for cesarean sections, the Sion Model can help to lower healthcare costs associated with maternal care. 4 Improved Efficiency and Quality of Care The Sion Model's focus on teamwork and evidence-based practices leads to a more efficient and effective healthcare system.
- 20. Factors influencing mode of delivery decision Maternal Health Pre-existing conditions, such as diabetes or heart disease, may necessitate a Cesarean section. Fetal Health Fetal position, size, or distress can influence the choice of vaginal birth or Cesarean section. Personal Preferences A mother's preference for a natural childbirth experience or a planned Cesarean section should be respected.
- 21. Personalized approach to mode of delivery Thorough Evaluation A detailed assessment of maternal and fetal health is crucial. Informed Discussion Open communication between the mother and healthcare provider is essential. Shared Decision-Making The mother and healthcare provider collaborate to determine the safest and most appropriate mode of delivery.
- 22. Sion Model Method: Revolutionizing Labor Induction The Sion Model, a novel approach to labor induction, has significantly impacted cesarean section rates. This model leverages mechanical dilatation methods, specifically Foley's catheter (24Fr) and Dinoprostone gel (250 ug – 500 ug)combination, to effectively dilate and open the cervix.
- 23. Insertion of 24 French Foley Catheter Preparation The patient's bladder is emptied, and the cervix is assessed to confirm its Dilation. Insertion The Foley catheter is gently inserted through the cervical os after informed detailed valid consent. Inflation The balloon at the tip of the catheter is inflated with sterile water depending on the POG from 30-60 ml, applying gentle pressure on the cervix.
- 24. Application of Dinoprostone Gel Dinoprostone Gel Dinoprostone, a synthetic prostaglandin, is applied to the cervix. It softens and dilates the cervix, promoting labor onset. Mechanism Dinoprostone mimics the natural hormones involved in labor, stimulating contractions and cervical ripening. Dosage The dosage and frequency of Dinoprostone gel application are carefully tailored to each patient's individual needs.
- 25. Patient Positioning and Traction Management Positioning The patient is typically encouraged to lie on their side or walk around, which helps promote cervical dilation and labor progress. Traction Gentle traction on the Foley catheter can be applied as the cervix dilates, further encouraging cervical opening and labor progression. Monitoring The patient's vital signs, cervical dilation, and fetal heart rate are closely monitored throughout the process.
- 26. Monitoring and Progression of the Procedure 1 Cervical Dilation The cervix is regularly assessed to track its progress, and the Foley catheter may be removed once adequate dilation is achieved. 2 Contractions The onset and intensity of contractions are monitored to ensure a safe and effective labor process. 3 Fetal Wellbeing Fetal heart rate and movement are closely observed to ensure the baby's well-being throughout the induction process. 4 Success Rate The Sion Model using Foley's catheter and Dinoprostone gel demonstrates a higher success rate compared to individual methods, contributing to the reduction of primary cesarean
- 27. - Written informed valid consent to be taken - To give patient a lithotomy position -Retract posterior vaginal wall with Sims speculum -Anterior vaginal wall retracted with A-V retractor to visualise cervix -Anterior lip of the cervix held with sponge-holding forceps
- 28. -Hold Foleys catheter with an artery forceps and insert into the internal os -Inflated with 50-80cc of normal saline -Tie a knot on one end of foley's catheter -Apply traction -To maintain traction, strap Foley’s catheter to thigh of patient
- 29. Smear Dinoprostone gel all around cervix/instil in posterior fornix Ask patient to remain in recumbent position for at least 30 minutes. Monitor foetal heart sound after induction Intrapartum monitoring recommended Foley's catheter not expelled out within 6 hours Continue FHS monitoring for 6 hours Repeat P/V examination after 6 hours Repeat Dinoprostone gel application (Precautions to be taken in previous LSCS patients) and FHS monitoring done Foley's bulb not expelled out Depending on patient status (High risk factors),P/V examination findings and fetal monitoring further decision for LSCS is taken If Foley’s catheter expelled out within 6 hours Do P/V examination -Cervix dilated, effacement improved -Consider augmentation of labour by Oxytocin or by Artificial rupture of membranes.
- 30. Vaginal Birth After Cesarean (VBAC) VBAC is a safe and successful option for many women who have had a previous Caesarean birth. It's an option that may reduce your risk of complications in future pregnancies.
- 31. Factors for VBAC Eligibility 1 Previous Cesarean Type The type of incision made during the previous Cesarean matters. A low transverse incision, the most common type, is usually favorable for a VBAC. 2 Previous Cesarean Reasons A VBAC is more likely if a previous C-section was due to reasons that are unlikely to recur, such as a breech position. 3 Number of Previous Cesareans Having had more than one Caesarean can influence your VBAC eligibility. Further need to discuss the risks and benefits. 4 Current Pregnancy Factors Factors like Cephalic Presentation Occiput position, gestational age, and overall health are assessed during pregnancy.
- 32. Inclusion criteria: 1) Singleton full term cephalic pregnancy 1) Primigravida 2) Multigravida 3) Previous 1 LSCS patients Exclusion criteria: 1) Contraindications for vaginal delivery cephalopelvic disproportion, contracted pelvis 2) Breech presentation and all malpresentation 3) Factors warranting an elective repeat caesarean like previous 2 LSCS, Previous classical caesarean, hysterotomy, myomectomy. Precautions to be taken: 1) Offer labour analgesia 2) Monitor for uterine hyperstimulation and abruption 2) Intrapartum foetal heart rate monitoring 3) In patient with scarred uterus, monitor signs of scar dehiscence like scar tenderness, maternal tachycardia, foetal bradycardia. 4) Senior obstetrician opinion recommended for decision regarding reinduction with Dinoprostone gel in case of a previous caesarean CRITERIA’S FOR SION MODEL
- 33. 0 5 10 15 20 25 30 35 Jul-23 Aug-23 Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 May-24 IOL Vaginal Delivery STATISTICS SHOWING SUCCESSFUL VAGINAL DELIVERY AFTER IMPLEMENTING SION MODEL
- 34. MONTH IOL WITH FOLEY’S AND DINOPROSTONE GEL VAGINAL DELIVERY SUCCESS RATE (%) JULY 23 32 24 75 % AUG 23 31 25 80 % SEPT 23 29 20 69 % OCT 23 30 22 73 % NOV 23 27 22 81 % DEC 23 28 19 67 % JAN 24 29 21 72 % FEB 24 30 22 73% MAR 24 25 19 76% APRIL 24 27 20 74% MAY 24 29 22 76% JUNE 24 28 21 75% TOTAL 345 257 74.49%
- 37. CONCLUSION • The SION model is a structured and networked approach to promoting vaginal deliveries. • By integrating education, support, policy implementation, and continuous improvement, it aims to enhance maternity care and reduce unnecessary C- sections through collaborative efforts among healthcare providers and patients. • Encouraging trials of labor after previous C-sections (TOLAC) and fostering a multidisciplinary team approach in maternity care are crucial. • Regular training for healthcare providers and establishing supportive hospital policies further promote vaginal births.