TY - JOUR
T1 - Mode of delivery among nulliparous women with single, cephalic, term pregnancies
T2 - The WHO global survey on maternal and perinatal health, 2004–2008
AU - Harrison, Margo S.
AU - Betrán, Ana Pilar
AU - Vogel, Joshua P.
AU - Goldenberg, Robert L.
AU - Gülmezoglu, A. Metin
PY - 2019/11
Y1 - 2019/11
N2 - Objective: To determine risk factors associated with cesarean delivery among nulliparous women in spontaneous labor with a single, cephalic, term pregnancy (Robson group 1). Methods: Data were assessed from the WHO Global Survey of Maternal and Perinatal Health conducted in 2004–2008. Results: Among 82 280 women in Robson group 1, 67 698 (82.3%) had vaginal and 14 578 (17.7%) had cesarean delivery. In adjusted analyses, maternal factors associated with cesarean included age older than 18 years, being overweight or obese, being married or cohabitating, attending four prenatal visits or more, and being medically high risk (P<0.001). Women who were obstetrically high risk, referred during labor, or at 39 gestational weeks or more were also more likely to undergo cesarean (all P<0.001). Facility-level factors associated with cesarean were availability of an anesthesia service 24/7, being a teaching facility, requirement of fees for cesarean, availability of electronic fetal monitoring, and having providers skilled in operative vaginal delivery (all P<0.01). Conclusion: The analysis highlights the importance of maintaining a healthy pre-pregnancy and pregnancy weight, optimizing management of women with medical problems, and ensuring clear referral mechanisms for women with intrapartum complications. The association between fees and cesarean delivery warrants further exploration.
AB - Objective: To determine risk factors associated with cesarean delivery among nulliparous women in spontaneous labor with a single, cephalic, term pregnancy (Robson group 1). Methods: Data were assessed from the WHO Global Survey of Maternal and Perinatal Health conducted in 2004–2008. Results: Among 82 280 women in Robson group 1, 67 698 (82.3%) had vaginal and 14 578 (17.7%) had cesarean delivery. In adjusted analyses, maternal factors associated with cesarean included age older than 18 years, being overweight or obese, being married or cohabitating, attending four prenatal visits or more, and being medically high risk (P<0.001). Women who were obstetrically high risk, referred during labor, or at 39 gestational weeks or more were also more likely to undergo cesarean (all P<0.001). Facility-level factors associated with cesarean were availability of an anesthesia service 24/7, being a teaching facility, requirement of fees for cesarean, availability of electronic fetal monitoring, and having providers skilled in operative vaginal delivery (all P<0.01). Conclusion: The analysis highlights the importance of maintaining a healthy pre-pregnancy and pregnancy weight, optimizing management of women with medical problems, and ensuring clear referral mechanisms for women with intrapartum complications. The association between fees and cesarean delivery warrants further exploration.
KW - Cesarean delivery
KW - Low- and middle-income countries
KW - Low-risk pregnancy
KW - Mode of delivery
KW - Risk factors
KW - Robson classification
KW - WHOGS
UR - http://www.scopus.com/inward/record.url?scp=85071542811&partnerID=8YFLogxK
U2 - 10.1002/ijgo.12929
DO - 10.1002/ijgo.12929
M3 - Article
C2 - 31353464
AN - SCOPUS:85071542811
SN - 0020-7292
VL - 147
SP - 165
EP - 172
JO - International Journal of Gynecology and Obstetrics
JF - International Journal of Gynecology and Obstetrics
IS - 2
ER -