A Prospective, Population-Based Study of Trends in Operative Vaginal Delivery Compared to Cesarean Delivery Rates in Low- and Middle-Income Countries, 2010–2016

Abstract

Objective Few data are available on cesarean delivery and operative vaginal delivery trends in low- and middle-income countries. Our objective was to analyze a prospective population-based registry including eight sites in seven low- and middle-income countries to observe trends in operative vaginal delivery versus cesarean delivery rates over time, across sites. Study Design A prospective population-based study, including home and facility births among women enrolled from 2010 to 2016, was performed in communities in Argentina, Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, and Zambia. Women were enrolled during pregnancy and delivery outcome data were collected. Results We analyzed 354,287 women; 4,119 (1.2%) underwent an operative vaginal delivery and 45,032 (11.2%) delivered by cesarean. Across all sites with data for 7 years, rates of operative vaginal delivery decreased from 1.6 to 0.3%, while cesarean delivery increased from 6.4 to 14.4%. Similar trends were seen when individual country data were analyzed. Operative vaginal delivery rates decreased in both hospitals and clinics, except in the hospital setting at one of the Indian sites. Conclusion In low- and middle-income countries, operative vaginal delivery is becoming less utilized while cesarean delivery is becoming an increasingly common mode of delivery.

Perinatal outcomes of babies delivered by second-stage Caesarean section versus vacuum extraction in a resource-poor setting, Nigeria – a retrospective analysis

“…Several studies have reported low incidence of AVD in many countries, including low-income countries of sub-Saharan Africa [1,3,9,10,12]. However, the recent increase in Caesarean section rates in many countries has not resulted in any significant improvement in neonatal outcomes [20].…”

“…While caesarean section rates have increased dramatically worldwide in the last decades [3][4][5][6], AVD is significantly under-utilized, particularly in sub-Saharan Africa; accounting for a meager 1% of institutional births [7][8][9][10]. Indeed, the decreasing trend in the utilization of AVD in low and middle-income countries has largely been attributed to decreasing experience with skills required for AVD [7,8].…”

Upsurge of caesarean sections in Pakistan: A qualitative study on perceptions of women and gynaecologists

“…Caesarean section rate has been varying in different parts of the world. In many countries, the rate of caesarean sections has reached 25% [6]. Likewise, most recent data indicate that the current rate of caesarean sections is 19.6% in Pakistan.…”

“…For that reason, Pakistan is amongst those developing countries that are responsible for the worldwide increase in caesarean sections [7]. Despite certain side effects and post-delivery complications, caesarean sections are emerging as the rst choice for childbearing worldwide [6].…”

Women's recommendations: vacuum extraction or caesarean section for prolonged second stage of labour, a prospective cohort study in Uganda

“…Despite its advantages, IVD is hardly used in many LMIC (<1% of institutional births), which is very different from many high‐income European countries that often have frequencies above 15% . A cross‐sectional health facility assessment in 40 countries in Latin America, sub‐Sahara Africa and Asia revealed that reasons for not using IVD were equipment related; lack of staff training; issues with authorisation of human resources and the perception amongst staff that no women with an indication for IVD had presented to the health facility .…”