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

BackgroundApproximately 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.ObjectiveTo assess the indications and outcome of cesarean section delivery among pregnant women utilizing delivery services in selected hospitals.MethodsA 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.ResultsNearly 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.ConclusionVaginal delivery results in more favorable feto-maternal outcomes than does cesarean delivery.