Use of Cesarean Birth among Robson Groups 2 and 4 at Mizan-Tepi University Hospital, Ethiopia

Abstract

Background. Primary cesarean birth rates were high among women who were either nulliparous (Group 2) or multiparous (Group 4) with a single, cephalic, term fetus who were induced, augmented, or underwent cesarean birth before labor in our study cohort. Objectives. The objective of this analysis was to determine what risk factors were associated with cesarean birth among Robson Groups 2 and 4. Methods. This study was a prospective hospital-based cross-sectional analysis of a convenience sample of 1,000 women who delivered at Mizan-Tepi University Teaching Hospital in the summer and fall of 2019. Results. Women in Robson Groups 2 and 4 comprised 11.4% (n = 113) of the total population (n = 993). The cesarean birth rate in Robson Group 2 (n = 56) was 37.5% and in Robson Group 4 (n = 57) was 24.6%. In Robson Group 2, of all prelabor cesareans (n = 5), one birth was elective cesarean by maternal request; the intrapartum cesarean births (n = 16) mostly had a maternal or fetal indication (93.8%), with one birth (6.2%) indicated by “failed induction or augmentation,” which was a combined indication. In Robson Group 4, all 4 women delivered by prelabor cesarean had a maternal indication (one was missing data), and 3 of the intrapartum cesareans were indicated by “failed induction or augmentation.” In multivariable modeling of Robson Group 2, having a labor duration of “not applicable” increased the risk of cesarean delivery (RR 2.9, CI (1.5, 5.4)). The odds of requiring maternal antibiotics was the only notable outcome with increased risk (RR 11.1, CI (1.9, 64.9)). In multivariable modeling of Robson Group 4, having a labor longer than 24 hours trended towards a significant association with cesarean (RR 3.6, CI (0.9, 14.3)), and women had a more dilated cervix on admission trended toward having a lower odds of cesarean (RR 0.8, CI (0.6, 1.0)). Conclusion. Though rates of primary cesarean birth among women who have a term, single, cephalic fetus and are induced, augmented, or undergone prelabor cesarean birth are high, those that occur intrapartum seem to be associated with appropriate risk factors and indications, though we cannot say this definitely as we did not perform an audit. More research is needed on the prelabor subgroup as a separate entity.

Performance of Integrated Emergency Surgical Officers at Mizan-Tepi University Teaching Hospital, Mizan-Aman, Ethiopia: A Retrospective Cohort Study

“…We conducted a hospital-based, prospective cross-sectional study at Mizan-Tepi University Teaching Hospital (MTUTH), which is located in Mizan-Aman in the Southern Nations, Nationalities, and People's Region (SNNPR), Ethiopia [ 19 ]. The study population was a convenience sample of all women who delivered at MTUTH between May 6 and October 21, 2019, which was the point at which 1,000 women were included in the cohort [ 19 ]. Only mothers who delivered after 28 weeks gestational age were included [ 19 ].…”

“…The study population was a convenience sample of all women who delivered at MTUTH between May 6 and October 21, 2019, which was the point at which 1,000 women were included in the cohort [ 19 ]. Only mothers who delivered after 28 weeks gestational age were included [ 19 ]. Deidentified data was collected by highly trained physicians with the objective of planning future quality improvement and research interventions [ 19 ].…”

“…Only mothers who delivered after 28 weeks gestational age were included [ 19 ]. Deidentified data was collected by highly trained physicians with the objective of planning future quality improvement and research interventions [ 19 ]. Physicians were involved in study design, but patients were not [ 19 ].…”

“…Deidentified data was collected by highly trained physicians with the objective of planning future quality improvement and research interventions [ 19 ]. Physicians were involved in study design, but patients were not [ 19 ]. A combination of structured interview and chart review was used to collect patient information upon admission, delivery, and discharge [ 19 ].…”

“…Physicians were involved in study design, but patients were not [ 19 ]. A combination of structured interview and chart review was used to collect patient information upon admission, delivery, and discharge [ 19 ]. Data was collected on paper forms, which were reviewed for completeness prior to data entry into REDCap [ 19 ].…”