Indications, Outcome and Risk Factors of Cesarean Delivery Among Pregnant Women Utilizing Delivery Services at Selected Public Health Institutions, Oromia Region, South West Ethiopia

Abstract

Background: Approximately 10% of deliveries are considered as high risk, which may require cesarean section. Besides, a rise in cesarean section delivery is a real public health concern; cesareans are costly and carry 8-12 and 8 times higher feto-maternal morbidity and mortality, respectively, as compared to vaginal delivery. Like in other countries where unnecessary cesarean delivery is performed, it is also rising in our country, posing potential risk to the mothers and their newborns. Objective: To assess the indications and outcome of cesarean section delivery among pregnant women utilizing delivery services in selected hospitals. Methods: A case-control study design was used among 488 randomly selected pregnant women attending delivery services in Bedelle and Mettu-Kharl Hospitals. Data were collected by interviewer-administered questionnaire and entered into EPI-data version 3.1 and exported to SPSS version 20 for cleaning and analyses. Binary logistic regression analysis was used to control for possible confounders. Association was declared at 95% CI and P-value <0.05 to assess the association between dependent and independent variables. Variables with P-values <0.05 at bivariate analysis were entered to final logistic regression model. Results: Nearly 30% and 24.6% of fetuses had been exposed to unfavorable outcome among those delivered following cesarean and vaginal delivery, respectively. The mean age of study participants was 25.79 (SD 6.76) for mothers who underwent cesarean delivery and 24.76 (SD 4.956) for their counterparts. Unfavorable maternal outcome was experienced by 20.5% and 14.7% of pregnant women who gave birth by cesarean and vaginal delivery, respectively. Those not having antenatal care follow-up were five times more likely to encounter unfavorable outcome than attendees (AOR 5.22, 95% CI 1.85-14.69), while mothers of newborns with low 5th minute Apgar score were 3 times (AOR 2.96, 95% CI 1.07, 8.16), multi-parity 7 times (AOR 7.22, 95% CI 1.45, 36.05) and rural residence were 1.29 times (AOR 1.29, 95% CI 5.09, 12.88) more likely to develop unfavorable feto-maternal outcome. Conclusion:Vaginal delivery results in more favorable feto-maternal outcomes than does cesarean delivery.

Proportion and associated factors of maternal complications of cesarean sections among mothers who deliver at Bahir Dar City Public Specialized Hospitals, Bahir Dar, Ethiopia

“…Cesarean section facilities are either not available or too far away for these women which render them to visit health facility after prolonged labor or after they experience at least one of obstetric complications which exposes the mother for complications. This finding was supported by previous studies done in Yirgalem and Oromia region, Ethiopia, which showed that rural women were 3 and 1.3 times more vulnerable for complication respectively [ 14 , 17 ].…”

“…The overall maternal complications were 44.04% (CI 95% 39.6–48.5). This finding is higher compared to other studies conducted in Debre Birhan (16.5%) [ 16 ], Jimma (28%) [ 12 ], Finote Selam (28%) [ 13 ], Oromia (20.5%) [ 14 ], Tigray (19.3%) [ 15 ], Yirgalem (30.1%) [ 17 ] and Arbaminch (38.2%) [ 18 ]. It is also higher than the finding in Germany (10.5%) [ 19 ], But it was relatively lower than the finding in Hawassa which was found to be 56% [ 20 ].…”

“…CD increases the risk of maternal morbidity, including hemorrhage, anesthetic complications, obstetric shock, cardiac arrest, acute renal failure, venous thromboembolism, surgical site infection, puerperal sepsis, hematoma, and maternal mortality [ 2 , 6 , 8 , 11 – 13 ]. In developed countries, febrile morbidity, puerperal sepsis, postpartum hemorrhage, surgical site infection, maternal mortality, and severe anemia were the most common CS complications [ 14 , 15 ].…”

Prevalence, Clinical Characteristics and Determinants of Unsuccessful Treatment Outcomes Among Pulmonary Tuberculosis Patients: A 5-Year Registry-Based Retrospective Cohort Study

“…Statistical Package for Social Science (SPSS) (version 23, IBM Corp. Armonk, N.Y., United States) was used in analyzing data. 16 Univariate analysis was used to assess the association between patients’ sociodemographic, microbiological, and clinical characteristics with unsuccessful treatment outcomes. To identify the ultimate predictors of unsatisfactory treatment outcomes, multiple logistic regression analysis was used to examine statistically significant factors in univariate analysis.…”

Preference of anesthesia types and associated factors among pregnant mothers scheduled for elective cesarean section in Addis Ababa Governmental Hospitals, Ethiopia: A Cross-Sectional Study

“…Spinal anesthesia is superior to General Anesthesia because, it has universal acceptance. But patients in many countries, including Ethiopia, still prefer GA and are afraid of regional block [3,[5][6][7].…”