Caesarean section rates analysed using Robson's 10-Group Classification System: a cross-sectional study at a tertiary hospital in Ethiopia

Magnitude, Indications, and Factors Associated With Operative Vaginal Delivery Among Mothers Who Gave Birth at Adama Hospital Medical College, Ethiopia, 2022

Introduction

Operative vaginal deliveries are a method of dealing with issues that arise during the second stage of labor with the use of vacuum device or forceps. The decision to use an instrument to deliver the fetus weighs the maternal, fetal, and neonatal consequences of the procedure against the alternative option of cesarean birth. However, evidence on operative vaginal delivery is limited in Ethiopia in general and in the study area in particular.

Objectives

This study aimed to assess the magnitude, indications, and factors associated with operative vaginal delivery among mothers who gave birth at Adama Hospital Medical College, Ethiopia.

Methods

A facility-based cross-sectional study was conducted among a sample of 440 mothers who gave birth from 1 to 30 June 2022. A systematic random sampling technique was used to select the study participants. Data were collected using an interviewer-administered structured questionnaire. The data were entered into EPI INFO version 7 and exported to SPSS version 25 for analysis. Bivariate logistic regression analysis was used to identify candidate variables at p < .25 and multivariable logistic regression analysis was used to identify the independent predictors of operative vaginal delivery at p < .05 with 95% confidence intervals (CIs).

Results

The magnitude of operative vaginal delivery was 14.8% (95% CI: 10.8, 18.8). Rural residence (adjusted odds ratio (AOR), 2.09; 95% CI: 2.01, 7.41), maternal age 25-34 (AOR, 4.95; 95% CI: 1.62, 9.2), being primigravida (AOR: 3.5, 95% CI: 1.26, 9.98), gestational age ≥42 weeks (3.09; 95% CI: 1.38, 6.9), and antenatal care (ANC) follow-ups <4 times (AOR:3.9; 95% CI: 1.09, 9.45) were significantly associated with operative vaginal delivery.

Conclusion

The magnitude of operative vaginal delivery in the study area was relatively low. Rural residence, maternal age 25 to 34, primigravida, gestational age ≥42 weeks, and ANC follow-ups <4 times were independent determinants of operative vaginal delivery. Thus, health education programs and other multidisciplinary strategies are required to encourage mothers to have regular ANC follow-ups.

Obstructed labor and its effect on adverse maternal and fetal outcomes in Ethiopia: A systematic review and meta-analysis

Background

Obstructed labor is one of the five major causes of maternal mortality and morbidity in developing countries. In Ethiopia, it accounts for 19.1% of maternal death. The current review aimed to assess maternal and perinatal outcomes of obstructed labor in Ethiopia.

Methods

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for this systematic review and meta-analysis. A literature search was made using PubMed/MEDLINE, CINAHL, Summon country-specific search, and Cochrane Libraries’ online databases. Search terms were adverse outcome, obstructed labor, maternal outcome, fetal outcome, and Ethiopia. The Newcastle-Ottawa scale (NOS), based on a star scoring system, was used to assess the quality of the included studies. The meta-analysis was conducted using STATA 16 software. The pooled prevalence of an adverse maternal outcome, fetal outcome, and association between adverse outcome and obstructed labor was calculated using a random-effects model. Egger’s test and funnel plot were used to evaluate publication bias.

Result

Eighty-seven studies were included in this review, with an overall sample size of 104259 women and 4952 newborns. The pooled incidence of maternal death was estimated to be 14.4% [14.14 (6.91–21.37). The pooled prevalence of uterine rupture and maternal near-miss was 41.18% (95% CI: 19.83, 62.54) and 30.5% [30.5 (11.40, 49.59) respectively. Other complications such as postpartum hemorrhage, sepsis, obstetric fistula, hysterectomy, bladder injury, cesarean section, and labor abnormalities were also reported. The pooled prevalence of perinatal death was 26.4% (26.4 (95% CI 15.18, 37.7). In addition, the association of obstructed labor with stillbirth, perinatal asphyxia, and meconium-stained amniotic fluid was also demonstrated.

Conclusions

In Ethiopia, the incidence of perinatal and maternal mortality among pregnant women with obstructed labor was high. The rate of maternal death and maternal near miss reported in this review was higher than incidences reported from high-income and most low and middle-income countries. Uterine rupture, postpartum hemorrhage, sepsis, fistula, hysterectomy, and bladder injury were also commonly reported. To improve the health outcomes of obstructed labor, it is recommended to address the three delay models: enhancing communities’ health-seeking behavior, enhancing transportation for an obstetric emergency with different stakeholders, and strengthening the capacity of health facilities to handle obstetric emergencies.

Prevalence, indications, and outcomes of operative vaginal deliveries among mothers who gave birth in Ethiopia: A systematic review and meta-analysis

Background

Operative vaginal deliveries represent an alternative to address problems during the second stage of labor. Clinicians have access to two different instruments obstetrics forceps and vacuum which should be conducted with indication. Understanding the pooled prevalence of operative vaginal deliveries, its indications, and outcomes would help in adopting suitable measures to reduce operative vaginal deliveries-related maternal and neonatal complications. Therefore, this systematic review and meta-analysis aimed to determine the prevalence, indications, and outcomes of operative vaginal deliveries among mothers who gave birth in Ethiopia.

Methods

A literature search was done through databases such as PubMed, SCOPUS, Web of Sciences, CAB Abstract, and CINHAL (EBSCO) to search studies that have been conducted in Ethiopia. Relevant sources were consulted to retrieve unpublished studies. Original observational studies that reported the prevalence, indication and outcomes of operative vaginal deliveries conducted in the English language were identified and screened. Studies were independently assessed for inclusion, data extraction, and risk of bias.

Results

Twelve studies were reviewed. The overall pooled prevalence of operative vaginal delivery among mothers who gave birth in Ethiopia was 10% (95% CI: 8 to 13) with I2 = 98.82% and a p-value ≤ 0.001. Fetal distress, prolonged labor, and maternal exhaustion were the most common feto-maternal indications of OVDs whereas; neonatal death, poor Apgar score, admission to neonatal intensive care unit, perianal tear, and postpartum hemorrhage were complications that occur following the operative vaginal deliveries in Ethiopia.

Conclusion

This systematic review and meta-analysis showed one out of 10 mothers undergo operative vaginal deliveries. Almost all feto-maternal complications that arise following operative vaginal deliveries were preventable. Thus, concerned stakeholders should encourage quality OVDs practice by avoiding unnecessary indications and scaling up the skill of health professionals through special training.

Systematic review registration

http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022311432.

Magnitude and associated factors of caesarean section deliveries among women who gave birth in Southwest Ethiopia: institutional-based cross-sectional study

BACKGROUND

Caesarean section is a life-saving comprehensive obstetric procedure of women and newborn performed during childbirth-related complications and should be universally accessible for all pregnant mothers globally. Appropriate use of caesarean section can reduce maternal and perinatal mortality. However, inappropriate use of caesarean section can negatively affect infant health, women health, and future pregnancies. The magnitude and factors associated with caesarean section delivery were not consistent and will vary between different hospitals of Ethiopia. Hence, this study aimed at assessing the magnitude and factors associated with caesarean section deliveries in Southwest Ethiopia.

METHODS AND MATERIALS

An institutional-based cross-sectional study was conducted from January 1 to February 29, 2020. A systematic random sampling technique was used to select 551 study participants. A pretested, structured, and face-to-face interview was used to collect data. Data were entered into Epi-data version 4.2.0 and exported to SPSS version 23 for analysis. Bivariate and multivariate analyses were used to identify factors associated with caesarean section deliveries. P values < 0.05 result were considered as a statistically significant association.

RESULTS

The magnitude of caesarean section deliveries was found to be 32.5 % (95 % CI; 28.6%-36.7 %). Mothers resided in an urban area [AOR = 2.58, (95% CI; 1.66-4.01)], multiple pregnancies [AOR = 3.15, (95% CI; 1.89-5.23), malpresentation [AOR = 3.05, (95% CI; 1.77-5.24)], and previous history of caesarean section [AOR = 3.55, (95% CI; 2.23-5.64) were factors associated with caesarean section deliveries.

CONCLUSIONS

Caesarean section deliveries were found high in the study area. Mothers resided in an urban area, multiple pregnancies, malpresentation, and previous history of caesarean section were factors associated with caesarean section deliveries. Therefore, counselling of mothers on the risk of giving birth through elective caesarean section without absolute and relative medical indications and giving enough time for the trial of vaginal birth after caesarean section are recommended.