Abstract
Objectives: We analyzed the indications of cesarean section (CS) using Robson Ten-Group. Classification Systems (RTGCS) and comparison between private and public health facilities in Addis Abeba hospitals, Ethiopia, 2017. Methods: Facility-based retrospective cross-sectional study was carried out between January 1 and December 31, 2017, including 2411 mothers who delivered by CS were classified using the RTGCS. Data were entered into SPSS version 20 for cleaning and analyzing. Binary logistic regression and AOR with 95% CI were used to assess the determinants of the CS. Results: The overall CS rate was 41% (34.8% and 66.8% in public & private respectively, p < .0001). The leading contributors for CS rate in the private were Robson groups 5,1,2,3 whereas in the public 5,1,3,2 on descending order. Robson group 1 (nulliparous, cephalic, term, spontaneous labor) and group 3 [Multiparous (excluding previous cesarean section), singleton, cephalic, ≥ 37 weeks’ gestation& spontaneous labor], the CS rate was over two-fold higher in the private than the public sector. Women in Robson groups 1, 2, 5 & 9 are two and more times higher for the absolute contribution of CS in private than public. The top medical indications of CS were non-reassuring fetal status (NRFS, 39.1%) and repeat CS for previous CS scars (39.4%) in public and private respectively. Mothers who delivered by CS in private with history of previous CS scar (AOR 2.9, 95% CI 1.4-6.2), clinical indications of maternal request (AOR 7.7, 95% CI 2.1-27.98) and pregnancy-induced hypertension (AOR 4.2, 95% CI 1.6-10.7), induced labor (AOR 2.5, 95% CI 1.4-4.6) and pre-labored (AOR 2.2, 95% CI 1.6-3.0) were more likely to undergo CS than in public hospital. Conclusion: The prevalence of CS was found to be high, and was significantly higher in private hospitals than in a public hospital. Having CS scar [having previous CS scar, Robson group 5(Previous CS, singleton, cephalic, ≥ 37 weeks’ gestation) and an indication of repeat CS for previous CS scar] is the likely factor that increased the CS rate in private when compared within the public hospital. Recommendation: It is important that efforts to reduce the overall CS rate should focus on reducing the primary CS, encouraging vaginal birth after CS (VBAC). Policies should be directed at the private sector where CS indication seems not to be driven by medical reasons solely.
Highlights
Cesarean section (CS) is the delivery of the fetus, membrane, and placenta through the abdominal wall and uterine incision after fetal viability [1,2], 28 weeks and above in Ethiopian context [3].Cesarean section rates are extraordinarily high in private for-pro it hospitals, and rates of 80% of all deliveries have been documented
Mothers who delivered by cesarean section (CS) section at the private hospital those who had previous CS scars, age ≥ 21 years, gestational age, ≥ 37 weeks, no spontaneous labor, medical indications, Robson groups (2,5,9) are more likely to deliver by CS than mothers who delivered in the public hospital
Mothers who delivered in private by CS whose age greater than 20 years (AOR 3.1, 95% CI 2.3-4.2) & > 34 years (AOR 5.0,95% CI 3.3-7.4), had previous Cs scar (AOR 2.9, 95% CI 1.4-6.2), a medical indication with the maternal request (AOR 7.7, 95% CI 2.1-27.98) and Pregnancy induced Hypertension (PIH) (AOR4.2, 95% CI 1.610.7), induced labor (AOR 2.5, 95% CI 1.4-4.6), prelabored CS (AOR 2.2, 95% CI 1.6-3.0) were more likely to undergo CS than public hospital (Table 7)
Summary
Cesarean section (CS) is the delivery of the fetus, membrane, and placenta through the abdominal wall (laparotomy) and uterine (hysteretomy) incision after fetal viability [1,2], 28 weeks and above in Ethiopian context [3].Cesarean section rates are extraordinarily high in private for-pro it hospitals, and rates of 80% of all deliveries have been documented. In 2015, WHO has endorsed the Robson Ten-Group Classi ication System (RTGCS) as a global standard tool for assessing, monitoring and comparing CS rates across different health care settings to propose and potentially implement effective measures to reduce CS rates [19,20] This system classi ies women into one of ten categories that are mutually exclusive but totally inclusive that is based on ive obstetric characteristics that are routinely collected in health facilities: 1) parity (nulliparous, multiparous with and without previous CS), 2) onset of labor (spontaneous, induced or pre-labour CS), 3) gestational age (preterm or term), 4) fetal presentation (cephalic, breech or transverse) and 5) number of fetuses (one or more than one, Table 1)
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