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Factors Associated with Cesarean Section among Primiparous Women in Georgia: A Registry-based Study.

ABSTRACT: Cesarean section rates remain high in Georgia. As a cesarean section in the first pregnancy generally lead to a cesarean section in subsequent pregnancies, primiparous women should be targeted for prevention strategies. The aim of the study was to assess factors associated with cesarean section among primiparous women. The study comprised 17,065 primiparous women with singleton, cephalic deliveries at 37-43 weeks of gestation registered in the Georgian Birth Registry in 2017. The main outcome was cesarean section. Descriptive statistics and logistic regression analysis were used to identify factors associated with cesarean section. The proportion of cesarean section was 37.1% with regional variations from 14.2% to 57.4%. Increased maternal age, obesity and having a baby weighing ?4000 g were all associated with higher odds of cesarean section. Of serious concern for newborn well-being is the high proportion of cesarean section at 37-38 weeks of gestation. Further research should focus on organizational and economical aspects of maternity care to uncover the underlying causes of the high cesarean section rate in Georgia.

SUBMITTER: Nedberg IH

PROVIDER: S-EPMC7758855 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Factors Associated with Cesarean Section among Primiparous Women in Georgia: A Registry-based Study.

Nedberg Ingvild Hersoug IH Rylander Charlotta C Skjeldestad Finn Egil FE Blix Ellen E Ugulava Tamar T Anda Erik Eik EE

Journal of epidemiology and global health 20200821 4

Cesarean section rates remain high in Georgia. As a cesarean section in the first pregnancy generally lead to a cesarean section in subsequent pregnancies, primiparous women should be targeted for prevention strategies. The aim of the study was to assess factors associated with cesarean section among primiparous women. The study comprised 17,065 primiparous women with singleton, cephalic deliveries at 37-43 weeks of gestation registered in the Georgian Birth Registry in 2017. The main outcome wa ...[more]

PMID: 33009731

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Project description:BackgroundCesarean section is an effective technique for preventing maternal and perinatal mortality when performed properly. Evidence suggested that pregnant women who have had good knowledge about their condition are able to participate in shared decision-making and can alleviate fears related to anesthesia. However, only a few studies have been conducted in Ethiopia assess the level of knowledge and attitude of pregnant women towards anesthesia for cesarean section.MethodsA hospital based cross-sectional study was conducted from April 18 to June 25, 2021. A total of 362 pregnant women attending antenatal care were selected using a systematic random sampling technique. Face-to-face interviews were used to collect data using pretested and structured questionnaires. For statistical analysis, both bivariate and multivariable binary logistic regression models were used. The adjusted odds ratio was used as the measure of association. At the 95% confidence level, a p-value of less than 0.05 was considered statistically significant.ResultsA total of 354 pregnant women from the ANC clinic participated, with a response rate of 97.8%. The overall proportion of good knowledge and a positive attitude towards anesthesia for cesarean section was 56.5% (95% CI: 51.4%, 61.9%) and 50.8% (95% CI: 45.8%, 56.2%), respectively. Pregnant women who had previous operations (AOR = 4.47, 95% CI: 1.77, 11.32) and had anesthesia-related health information (AOR = 10.06, 95% CI: 5.41, 18.69) had significantly better knowledge of anesthesia for cesarean section. Pregnant women who had secondary education (AOR = 6.71, 95% CI: 1.19, 37.99), college and above education (AOR = 13.63, 95% CI: 2.26, 82.21), and had health information about anesthesia (AOR = 2.02, 95% CI: 1.09, 3.77) significantly associated with a positive attitude towards anesthesia for CS.ConclusionThis finding indicates that a significant number of pregnant women continue to have inadequate knowledge and attitudes towards anesthesia for CS. Previous operations and anesthesia-related health information were significantly associated with knowledge, whereas higher education and anesthesia-related health information were significantly associated with a positive attitude towards anesthesia for cesarean section. Health professionals must provide anesthesia-related health information to mothers with CS indications during ANC visits and in operating theater areas.

Project description:IntroductionPlacenta accreta spectrum (PAS) may cause enormous and potentially life-threatening hemorrhage in the intrapartum and postpartum periods in emergency cesarean section. How to reduce the occurrence of emergency cesarean section in patients with severe PAS is the key to reducing the adverse outcomes of them. This study aimed to investigate the impact of emergency cesarean section on the perioperative outcomes of pregnant women with PAS and neonates, and also aimed to explore the risk factors of emergency cesarean section in pregnant women with PAS.Materials and methodsA retrospective investigation was conducted among 163 pregnant women with severe PAS. Of these, 72 were subjected to emergency cesarean sections. Data on the perioperative characteristics of the mothers and neonates were collected. Multivariable linear regression analysis was used to detect associations between maternal and perioperative characteristics and volume of intraoperative bleeding. Binary logical regression was used to analyze the association between maternal preoperative characteristics and emergency cesarean section. Linear regression analysis is used to analyze the relationship between gestational age and emergency cesarean section.ResultsThe risks of emergency cesarean section increase 98, 112, 124, and 62% when the pregnant women with PAS accompanied by GHD, ICP, more prior cesarean deliveries and more severe PAS type, respectively. Noteworthy, the risk of emergency cesarean section decreases 5% when pre-pregnancy BMI increases 1 kg/m2 (OR: 0.95; CI: 0.82, 0.98; p = 0.038). Moreover, there is no significant linear correlation between emergency cesarean section and gestational age.ConclusionGHD, ICP, multiple prior cesarean deliveries and severe PAS type may all increase the risk of emergency cesarean section for pregnant women with PAS, while high pre-pregnancy BMI may be a protective factor due to less activity level. For pregnant women with severe PAS accompanied by these high risk factors, more adequate maternal and fetal monitoring should be carried out in the third trimester to reduce the risk of emergency cesarean section.

Dataset Information

Factors Associated with Cesarean Section among Primiparous Women in Georgia: A Registry-based Study.

Publications

Factors Associated with Cesarean Section among Primiparous Women in Georgia: A Registry-based Study.

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