Predictive Factors of Cesarean Section in Primiparous Women in a Secondary Hospital
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Abstract
Objective: To analyze predictive factors for cesarean section in primiparous women delivering at a secondary hospital. Methods: A retrospective analytical study was conducted using medical records of 190 primiparous women who delivered at a secondary hospital between January 1 and December 31, 2023. Data were analyzed using descriptive statistics and multivariate logistic regression. Results: Among the 190 participants, 78 (41.05%) underwent cesarean section. Factors significantly associated with cesarean section included maternal age over 35 years (adjusted OR 2.14, 95% CI 1.25-3.67, p = .005) body mass index ≥ 30 kg/m2 (adjusted OR 4.22, 95% CI 1.78-9.99, p = .001) estimated fetal weight >3,500 grams (adjusted OR 3.78, 95% CI .75-19.06, p = .107) maternal underlying diseases (adjusted OR 2.18, 95% CI 1.16-4.10, p=.015) fetal head circumference >34 cm (adjusted OR 2.21, 95% CI 1.19-4.09, p = .011) private antenatal care (adjusted OR 20.00, 95% CI 2.54-157.34, p < .001) birth weight > 3,500 grams. (adjusted OR 3.57, 95% CI 1.22-10.45, p = .02) and physician experience of more than 5 years. (adjusted OR 2.37, 95% CI 1.21-4.64, p = .012) Conclusion: Key predictors of cesarean section in primiparous women at a secondary hospital include maternal age over 35 years, high body mass index, maternal underlying diseases, fetal head circumference >34 cm, private antenatal care, birth weight >3,500 grams, and physician's experience of more than 5 years. These findings can inform the development of care guidelines and counseling for primiparous women to reduce unnecessary cesarean sections in secondary hospitals.
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References
World Health Organization. Caesarean section rates continue to rise, amid growing inequalities in access [Internet]. Geneva: WHO; 2021 [cited 2024 Nov 3]. Available from: https://www.who.int/news/item/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access
Mueller NT, Differding MK, Østbye T, et al. Association of birth mode of delivery with infant faecal microbiota, potential pathobionts, and short chain fatty acids: A longitudinal study over the first year of life. BJOG. 2021; 128(8): 1293-303. doi: 10.1111/1471-0528.16633.
Yan J, Wang L, Yang Y, et al. The trend of caesarean birth rate changes in China after ‘universal two-child policy’era: A population-based study in 2013–2018. BMC Med. 2020; 18: 1-9. doi: 10.1186/s12916-020-01714-7.
Sungkar A, Basrowi RW. Rising trends and indication of caesarean section in Indonesia. World. Nutr. J. 2020; 4(2): 1-7. doi: 10.25220/WNJ.V04.S2.0001.
Patamasingh Na Ayudhaya O, Kittikraisak W, Phadungkiatwatana P, et al. Evaluation of cesarean delivery rates and factors associated with cesarean delivery among women enrolled in a pregnancy cohort study at two tertiary hospitals in Thailand. BMC Pregnancy Childbirth. 2024; 24(1): 149. doi: 10.1186/s12884-024-06314-4.
Mojtahedi MF, Sepidarkish M, Almukhtar M, et al. Global incidence of surgical site infections following caesarean section: A systematic review and meta-analysis. J Hosp Infect. 2023; 139: 82-92. doi: 10.1016/j.jhin.2023.05.019.
Bosson-Amedenu S, Anafo A, Ouerfelli A, et al. Examining cesarean section rates in Ghana's 10 regions over a decade a comprehensive national investigation. Biomed Res Int. 2024; 2024: 3774435. doi: 10.1155/2024/3774435.
Visser GH, Ubom AE, Neji K, et al. FIGO opinion paper: Drivers and solutions to the cesarean delivery epidemic with emphasis on the increasing rates in Africa and Southeastern Europe. Int J Gynaecol Obstet. 2023; 163(Suppl2): 5-9. doi: 10.1002/ijgo.15111.
Ahmed MS, Islam M, Jahan I, et al. Multilevel analysis to identify the factors associated with caesarean section in Bangladesh: Evidence from a nationally representative survey. International Health. 2023; 15(1): 30-6. doi: 10.1093/inthealth/ihac006.
Harrison MS, Garces AL, Goudar SS, et al. Cesarean birth in the Global Network for Women's and Children's Health Research: Trends in utilization, risk factors, and subgroups with high cesarean birth rates. Reprod Health. 2020; 17(Suppl3): 165. doi: 10.1186/s12978-020-01021-7.
Gedefaw G, Demis A, Alemnew B, et al. Prevalence, indications, and outcomes of caesarean section deliveries in Ethiopia: A systematic review and meta-analysis. Patient Saf Surg. 2020; 14: 1-10. doi: 10.1186/s13037-020-00236-8.
Labor and Delivery Statistics, Ramathibodi Chakri Naruebodindra Hospital. Annual report 2022. Samut Prakan: Ramathibodi Chakri Naruebodindra Hospital; 2023. Thai.
Frick AP. Advanced maternal age and adverse pregnancy outcomes. Best Pract Res Clin Obstet Gynaecol. 2021; 70: 92-100. doi: 10.1016/j.bpobgyn.2020.07.005.
Attali E, Yogev Y. The impact of advanced maternal age on pregnancy outcome. Best Pract Res Clin Obstet Gynaecol. 2021; 70: 2-9. doi: 10.1016/j.bpobgyn.2020.06.006.
Jevitt CM. Management of labor and delivery to reduce risk for cesarean birth in eomen with obesity. Curr Obstet Gynecol Rep. 2023; 12(2): 103-16. doi: 10.1007/s13669-023-00361-y.
Chiavarini M, De Socio B, Giacchetta I, et al. Overweight and obesity in adult birth by cesarean section: A systematic review with meta-analysis. J Public Health Manag Pract. 2023; 29(2): 128-41. doi: 10.1097/PHH.0000000000001687.
Deshpande RR, Matsuzaki S, Cox KR, et al. Incidence, characteristics, and maternal outcomes of pregnancy with uterine prolapse. Am J Obstet Gynecol MFM. 2023; 5(8): 101020. doi: 10.1016/j.ajogmf.2023.101020.
Machado-Gédéon A, Badeghiesh A, Baghlaf H, et al. Adverse pregnancy, delivery and neonatal outcomes across different advanced maternal ages: A population-based retrospective cohort study. Eur J Obstet Gynecol Reprod Biol X. 2023; 17: 100180. doi: 10.1016/j.eurox.2023.100180.
Khan MN, Kabir MA, Shariff AA, et al. Too many yet too few caesarean section deliveries in Bangladesh: Evidence from Bangladesh Demographic and Health Surveys data. PLOS Glob Public Health. 2022; 2(2): e0000091. doi: 10.1371/journal.pgph.0000091.
Tienmontree K, Chunuan S, Kala S. Factors influencing decision-making for cesarean section among primigravidae. NJPH. 2021; 31(1): 96-109. Thai.
Sentilhes L, Madar H, Ducarme G, et al. Outcomes of operative vaginal delivery managed by residents under supervision and attending obstetricians: A prospective cross-sectional study. Am J Obstet Gynecol. 2019; 221(1): 59.e1-15. doi: 10.1016/j.ajog.2019.02.044.
Hsieh FY, Lavori PW, Cohen HJ, et al. An overview of variance inflation factors for sample-size calculation. Eval Health Prof. 2003; 26(3): 239-57. doi: 10.1177/0163278703255230.
Zeevi G, Zlatkin R, Hochberg A, et al. Is there an age limit for a trial of vaginal delivery in Nulliparous women?. J Clin Med. 2023; 12(11): 3620. doi: 10.3390/jcm12113620.
Osterman MJK, Hamilton BE, Martin JA, et al. Births: Final data for 2020. Natl Vital Stat Rep. 2022; 70(17): 1-50. doi: 10.15620/cdc:112078.
Rudey EL, do Carmo Leal M, Rego G. Cesarean section rates in Brazil: Trend analysis using the Robson classification system. Medicine (Baltimore). 2020; 99(17): e19880. doi: 10.1097/MD.0000000000019880.