Risk factors for cesarean section in women of urban Puducherry, India: A matched case–control study
Cesarean section (CS) is generally performed either to ensure maternal and child safety when vaginal delivery is not possible. The WHO has indicated that CS rates of more than 10% are considered overutilization. Increased CS rates can cause an increase in postpartum antibiotic treatment and longer hospital stay. In this research, we conducted a matched case–control study, including all women who gave birth through CS and resided in the study area over a 3-year period before the survey as cases and similar age- and year-matched women who had normal vaginal delivery during the same period as controls. The data were collected using a semi-structured pro forma through personal interviews and verified with discharge cards. We obtained a sample of 140 women (70 matched cases and controls) as study participants. Our results show that unadjusted analysis revealed socioeconomic status, history of gestational diabetes mellitus, previous lower segment CS (LSCS), and malpresentation emerged as risk factors, whereas in the adjusted analysis, we observed that previous LSCS (aOR 45.4 [4.3 – 483.6]), malpresentation (aOR 11.0 [1.6 – 73.8]), and belonging to middle (aOR 3.3 [1.0 – 10.8]) and upper class (aOR 23.55 [CI: 1.2 – 463.8]) remained as independent risk factors. Our study identified independent risk factors for CS that needs to be tackled for bringing down the CS rates.
Ahmmed, F., Manik, M. M. R., & Hossain, M. J. (2021). Caesarian section (CS) delivery in Bangladesh: A nationally representative cross-sectional study. PLoS One, 16(7), e0254777. https://doi.org/10.1371/journal.pone.0254777
Arjun, G. (2008). Caesarean section: Evaluation, guidelines and recommendations. Indian Journal of Medical Ethics, 5(3), 117-120. https://doi.org/10.20529/IJME.2008.043
Begum, T., Rahman, A., Nababan, H., Hoque, D. E., Khan, A. F., Ali, T., et al. (2017). Indications and determinants of caesarean section delivery: Evidence from a population-based study in Matlab, Bangladesh. PLoS One, 12(11), e0188074. https://doi.org/10.1371/journal.pone.0188074
Betrán, A. P., Merialdi, M., Lauer, J., Bing-Shun, W., Thomas, J., Van Look, P., et al. (2007). Rates of caesarean section: analysis of global, regional and national estimates. Paediatric and Perinatal Epidemiology, 21(2), 98-113. https://doi.org/10.1111/j.1365-3016.2007.00786.x
Betrán, A., Torloni, M., Zhang, J., Gülmezoglu, A. M., & WHO Working Group on Caesarean Section. (2016). WHO statement on caesarean section rates. BJOG, 123(5), 667. https://doi.org/10.1111/1471-0528.13526
Betran, A., Ye, J., Moller, A., Souza, J. P. and Zhang, J. (2021). Trends and projections of caesarean section rates: global and regional estimates. BMJ Global Health, 6(6), e005671. https://doi.org/10.1136/bmjgh-2021-005671
Bhasker, R. K. (1994). Global Aspects of a Rising Caesarean Section Rate. In: Women’s Health Today: Perspectives on Current Research and Clinical Practice. Montreal: The Proceedings of the 14th World Congress of Obstetrics and Gynaecology, p.59-64.
Boehm, F. H. and Graves, C. R. (1994) Caesarean birth. In: ME Rivlin and RW Martin (eds.). Manual of Clinical Problems in Obstetrics and Gynecology. Boston: Little Brown, p.158-162. Available from: https://pide.org.pk/pdfseminar/seminar- 2015-11-determinants-of-cesarean-deliveries-in-pakistan.pdf [Last accessed on 2022 Feb 04].
Festin, M. R., Laopaiboon, M., Pattanittum, P., Ewens, M. R., Henderson-Smart, D. J., Crowther, C. A., et al. (2009). Caesarean section in four South East Asian countries: Reasons for, rates, associated care practices and health outcomes. BMC Pregnancy and Childbirth, 9(1), 17. https://doi.org/10.1186/1471-2393-9-17
Gibbons, L., Belizán, J., Lauer, J., Betrán, A. P., Merialdi, M., & Althabe, F. (2010). The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: Overuse as a barrier to universal coverage. World Health Report, 30(1), 1-31.
Kambo, I., Bedi, N., Dhillon, B., & Saxena, N. C. (2002). A critical appraisal of cesarean section rates at teaching hospitals in India. International Journal of Gynecology and Obstetrics, 79(2), 151-158. https://doi.org/10.1016/s0020-7292(02)00226-6
Lauer, J., Betrán, A., Merialdi, M., & Wojdyla, D. (2010). Determinants of caesarean section rates in developed countries: Supply, demand and opportunities for control. World Health Report, 29, 1-22.
Li, H., Hellerstein, S., Zhou, Y., Liu, J. M., & Blustein, J. (2020). Trends in cesarean delivery rates in China, 2008-2018. JAMA, 323(1), 89-91. https://doi.org/10.1001/jama.2019.17595
Majhi, M. M. & Bhatnagar, N. (2021). Updated BG Prasad’s classification for the year 2021: Consideration for new base year 2016. Journal of Family Medicine and Primary Care, 10(11), 4318-4318. https://doi.org/10.4103/jfmpc.jfmpc_987_21
Matkar, R. (2017). Children Are the Future of the Nation (With Reference to National Family Health Survey [NFHS] Round 3 and 4 IE 2005-06 and 2015-16). In: 7th International Scientific Forum, p.134. Available from: https://eujournal.org/index. php/esj/article/view/9195 [Last accessed on 2022 Mar 31].
Ming, Y., Huang, R., Zhou, W., Wang, B., Yu, H., & Zhang, J. (2019). Is age and socioeconomic status associated with preference for birth mode in nulliparous women in China? Archives of Gynecology and Obstetrics, 300(1), 33-40. https://doi.org/10.1007/s00404-019-05140-w
Mohan, D., Iype, T., Varghese, S., Usha, A., & Mohan, M. (2019). A cross-sectional study to assess prevalence and factors associated with mild cognitive impairment among older adults in an urban area of Kerala, South India. BMJ Open, 9(3), e025473. https://doi.org/10.1136/bmjopen-2018-025473
Panda, S., Begley, C., & Daly, D. (2018). Clinicians’ views of factors influencing decision-making for caesarean section: A systematic review and meta-synthesis of qualitative, quantitative and mixed methods studies. PLoS One, 13(7), e0200941. https://doi.org/10.1371/journal.pone.0200941
Poobalan, A., Aucott, L., Gurung, T., Smith, W. C. S., & Bhattacharya, S. (2009). Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women-systematic review and meta‐analysis of cohort studies. Obesity Reviews, 10(1), 28-35. https://doi.org/10.1111/j.1467-789X.2008.00537.x
Rajaa, S., Priyan, S., Lakshminarayanan, S., & Kumar, G. (2019). Health information needs assessment among self-help groups and willingness for involvement in health promotion in a rural setting in Puducherry: A mixed-method study. Journal of Education and Health Promotion, 8, 186. https://doi.org/10.4103/jehp.jehp_35_19
Roy, N., Mishra, P., Mishra, V., Chattu, V. K., Varandani, S., & Batham, S. K. (2021). Changing scenario of C-section delivery in India: Understanding the maternal health concern and its associated predictors. Journal of Family Medicine and Primary Care, 10(11), 4182. https://doi.org/10.4103/jfmpc.jfmpc_585_21
Soni, A., Sharma, C., Verma, S., Justa, U., Soni, P. K., & Verma, A. (2015). A prospective observational study of trial of labor after cesarean in rural India. International Journal of Gynecology and Obstetrics, 129(2), 156-160. https://doi.org/10.1016/j.ijgo.2014.11.007
Srivastava, S., Chaurasia, H., Singh, K., & Chaudhary, P. (2020). Exploring the spatial patterns of cesarean section delivery in India: Evidence from national family health survey-4. Clinical Epidemiology and Global Health, 8(2), 414-422. https://doi.org/10.1016/j.cegh.2019.09.012
Stata Corp. (2012) Intercooled Stata. 12th ed. Houston, TX: Stata Corp. Available from: http://www.stata.com/stata12 [Last accessed on 2018 Jul 16].
Villar, J., Valladares, E., Wojdyla, D., Zavaleta, N., Carroli, G., Velazco, A., et al. (2006). Caesarean delivery rates and pregnancy outcomes: The 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet, 367(9525), 1819-1829. https://doi.org/10.1016/S0140-6736(06)68704-7
Wehberg, S., Guldberg, R., Gradel, K., Kesmodel, U. S., Munk, L., Andersson, C. B., et al. (2018). Risk factors and between-hospital variation of caesarean section in Denmark: A cohort study. BMJ Open, 8(2), e019120. https://doi.org/10.1136/bmjopen-2017-019120
Witt, W., Wisk, L., Cheng, E., Mandell, K., Chatterjee, D., Wakeel, F., et al. (2015). Determinants of cesarean delivery in the US: A lifecourse approach. Maternal and Child Health Journal, 19(1), 84-93. https://doi.org/10.1007/s10995-014-1498-8