Risk factors associated with cesarean delivery in pregnant women: Kwanza North Hospital, Angola, 2017

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Since 1985, the international healthcare community has considered the ideal rate for caesarean sections (CS) to be between 10% and 15%. Over the last decades, there is concern about the rise in CS and the potential negative consequences for maternal/infant health, especially in Sub-Saharan Africa, where, according to WHO the quality of surgical procedures is sub-optimal and the rate of maternal deaths are higher than in western world. We aimed to evaluate the risk factors for CS at a provincial Maternal and Children Hospital (MCH) in Kwanza-North, Angola.
A 1:2 case-control study was conducted between January and December 2017 among 540 pregnant women (180 cases, 360 controls) who had delivered at the MCH. Cases were defined as women who underwent CS, whereas controls were pregnant women with vaginal deliveries. Semi-structured questionnaires were used for primary data, whereas secondary data was obtained through the review of clinical files. Significance level was set at p<0.05 for all hypothesis tests. Pearson chi-squared (χ2) tests, followed by multivariable logistic regression modeling were used to identify factors associated with CS.
The sample of 540 CS represents 17.7% of all the 1928 pregnant women that had a delivery during the study period. The risk factors identified for CS were: previous CS (Adjusted OR: 8.2; 95%CI: 6.8-15.6); Fetal distress (Adjusted OR: 26.4; 95%CI: 18.4-48.6); Cephalopelvic disproportion (Adjusted OR: 28.0; 95%CI: 17.6-50.9); Premature rupture of membranes (Adjusted OR: 29,0; 95%CI: 18,6-49,4); Placenta previa (Adjusted OR: 12.4; 95%CI: 7.8-22.6); and retro- placental haematoma (Adjusted OR: 11.6; 95%CI: 7.6-19.0).
Even though the prevalence of CS in the MCH of Kwanza-North was higher than recommended by the international community, our study showed that the risk factors identified for CS are indeed the classical CS medical indications. Future studies using the Robson classification as recommended by WHO are warranted to allow for an optimization of the use of CS by focusing interventions on specific groups of particular relevance for each health facility.

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