Cesarean Section Rate in a Sample of Primigravida Women in the Public Maternity Hospital in Erbil City, Iraq

Abstract

IntroductionCesarean section is usually performed when a vaginal delivery would put the baby's or mother's life or health at risk. Cesarean section can save lives, but it is frequently performed without medical indications (1). It is often done as an emergency procedure in women with cephalopelvic disproportion, obstructed labor, fetal distress, antepartum hemorrhage and previous cesarean section resulting in high perinatal and maternal morbidities (2).Cesarean section rates have risen worldwide. A study that involved 150 countries reported a rate of 18.6% ranging from 6% in the least developed countries to 27.2% in the most developed countries. Cesarean section rates are highest in the Latin America and the Caribbean region (40.5%) and Northern America (32.3%), while they are lowest in Asia (19.2%) and Africa (7.3%) (3). In the Arab countries, cesarean section rates vary widely with Egypt having the highest cesarean section rate (26.2%) and Mauritania the lowest (5.3%) (4).Studies from industrial countries have shown that the indications for the cesarean section have changed over the last decades and increased knowledge about current indications could lead to the reduction of cesarean section rates through correct counseling and advice to pregnant women and health workers (5-8).The worldwide increase in cesarean section rate which might be associated with maternal factors and health care services provided the impetus for carrying out this study. It is important to ensure that a cesarean section is provided to women in real need. This study aimed to determine the rate of cesarean section in a sample of primigravida women and find out the association between the cesarean section rate and the socio-demographic characteristics of pregnant women, pregnancy risk factors, and the utilization of antenatal care services. Materials and MethodsThis cross-sectional study was conducted at Erbil Maternity Teaching Hospital in Kurdistan region of Iraq from 1st of July, 2015 to 30th of June, 2016. A sample of 400 primigravida women was selected for the study by convenient sampling technique. All the primigravida women who were present in Erbil Maternity Teaching Hospital in the days when the researcher was attending the hospital for data collection were invited to participate in the study. The study included the primigravida women AbstractObjectives: The worldwide rise in the cesarean section rates might be associated with maternal factors and health care services. This study aimed to measure the rate of cesarean section in a sample of primigravida women and find out the association of the cesarean section rate with the socio-demographic characteristics of pregnant women, pregnancy risk factors, and the utilization of antenatal care services. Materials and Methods: A cross-sectional study was carried out from the 1st of July, 2015 to 30th of June, 2016. The study sample included 400 primigravida women with singleton pregnancy at the labor room of Erbil Maternity Teaching Hospital. A specially designed questionnaire was used fo...

Association of Maternal Anemia and Cesarean Delivery: A Systematic Review and Meta-Analysis

“…An additional nine studies were then excluded because they did not provide specific data about CD or anaemia. Therefore, 14 studies conducted between 2002 and 2019 that enrolled a total 336,128 pregnant women were finally included in our meta-analysis [ 6 , 8 , 9 , 10 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. All 14 studies were good quality studies and had the least risk of bias according to the NOS score ( Table 1 ) and Cochrane collaborate tool ( Figure 2 ).…”

“…Of the fourteen studies, two were conducted in Europe [ 21 , 26 ], three in Africa [ 22 , 23 , 27 ], three in India [ 9 , 19 , 24 ], two in Israel [ 6 , 10 ], one in New Zealand [ 8 ], one in Jordan [ 25 ], one in Pakistan [ 28 ], and one in Iraq [ 20 ]. The number of included women ranged from 382 [ 8 ] to 153,396 [ 6 ].…”

“…The number of included women ranged from 382 [ 8 ] to 153,396 [ 6 ]. Nine studies used the WHO cut-off of 11 g/dL haemoglobin for the diagnosis of anaemia [ 8 , 9 , 10 , 19 , 20 , 21 , 22 , 23 , 25 , 26 , 27 ], while five studies adopted the CDC cut-off of <10.5 g/dL [ 6 , 22 , 23 , 24 , 28 ] ( Table S3 ). In over half of the studies (n = 9, 64.2%) [ 10 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 28 ], haemoglobin was measured in the third trimester or at delivery, while it was measured in the first trimester in four studies [ 6 , 8 , 9 , 24 ] and the second trimester [ 26 ] in one study.…”

“…In the subgroup analysis, anaemic women were found to be at higher risk for CD in studies from both low-middle-income (n = 8) [ 8 , 20 , 21 , 22 , 25 , 26 , 27 , 28 ] and high-income countries (n = 6) [ 6 , 8 , 10 , 21 , 23 , 26 ] ( Figure 6 ). Moreover, anaemic women were at higher risk for CD regardless of the haemoglobin cut-off point (10.5 g/dL or 11 g/dL) ( Figure 7 ).…”

“…However, detection in the first trimester is difficult in sub-Saharan countries, such as Sudan and South Africa, as pregnant women in these countries report late for antenatal care. In most of the included studies in this review (n = 9, 64.2%) [ 10 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 28 ], haemoglobin was measured during the third trimester, while four studies [ 6 , 8 , 9 , 24 ] measured it in the first trimester and one study measured it in the second trimester [ 26 ]. We investigated the impact of the time at which haemoglobin was measured on the risk of CD, but it was not significant.…”