Cesarean Section: Incidence, Causes, Associated Factors and Outcomes: A National Prospective Study from Jordan

Abstract

Objectives: To determine the rate of cesarean section (CS) in Jordan and its causes, associated factors, and neonatal outcomes. Methods:The study is part of a comprehensive national study of perinatal mortality which was conducted between 2011 and 2012 in Jordan. The study was concurrent prospective in design. A sample of 18 hospitals with maternity departments was selected. All women ≥ 20 weeks of gestation admitted for delivery in any of the 18 selected hospitals were enrolled in the study. Data were collected by interviews and abstraction of data from medical records. Results:The overall rate of CS was 29.1% (13.2% as emergency CS and 15.9% as planned CS). Health sector, income of >350, <12 years of education, increased gestational age at delivery, primiparity, previous CS, male gender, overweight, obesity, pre-gestational and gestational diabetes, non-cephalic presentation, multiple pregnancy, preeclampsia, anemia, smoking, history of neonatal death/stillbirth, and previous hospitalization during current pregnancy were all associated with increased odds of CS in the multivariate analysis. The most frequent reason for planned CS was scarred uterus (59.4%) and for emergency CS was prolonged fetal distress (30.0%). The neonatal death rate was significantly higher (p=0.000) for planned CS (2.1%) and emergency CS (2.5%) as compared to vaginal delivery (0.9%). Conclusion:The rate of CS in Jordan is high (29.1%). CS is associated with increased risk of neonatal death. As most CSs are currently based on physician's judgment, it may be extremely useful to develop and implement national guidelines for performing CS. Obstetricians' adherence to these guidelines should be strictly monitored.

Prevalence, Indications and Determinants of Caesarean Delivery in Alexandria, Egypt

“…Whereas consistent high rates up to100% were observed in some areas (11,13,18,19) lower rates were recorded in others. (10,13,21) Similar to earlier reports (4,7,8,11,18,21) CD was significantly linked to private health services in our univariate and multivariate analysis. Some authors suggested that the rising rate of the planned CD in private sector is due to unnecessary CS and not to increasing obstetric risk.…”

“…(1,4,20) In consistence, previous CD was the leading indication of CD in the present as well in previous Egyptian (7,(14)(15)(16)(17) and non-Egyptian studies . (3,4,10,12,21,22) Also, previous CS was a main predictor for CS in the present and similar studies. (10,19) Moreover, Witt et al elicited that having earlier CS was the strongest predictor of non-indicated CS .…”

“…(3,4,10,12,21,22) Also, previous CS was a main predictor for CS in the present and similar studies. (10,19) Moreover, Witt et al elicited that having earlier CS was the strongest predictor of non-indicated CS . (19) Obstetricians may repeat CS to refrain from practicing vaginal after CD; to avoid risk, or due to doubtful scar strength or absent information of the previous CS .…”

“…This rate is by far higher than the maximum threshold accepted by the WHO (15%) (1) (5) Our level is also higher than those recorded in other Arab countries (17.8%-55.5%). (9)(10)(11)(12) However, it coincides with the highest rate observed in another study over 169 worldwide countries (70.2% within Brazil). (4) In contrast, extremely lower rates below 5% and down to 2.3% were seen in many African countries.…”

“…( 1,3,4,6,11,18) Non-medical illegitimate causes as financial reasons, training of juniors and saving time would not be reported . (10) Increasing frequency of repeated CS is a prominent cause. (1,4) Higher CD rate was also linked to higher socioeconomic status (3,4,7,8,11,13,19) and experiencing a preconception stressful life event.…”