Exploring the impact of indication on variation in rates of intrapartum caesarean section in six Palestinian hospitals: a prospective cohort study.

Autor: Zimmo MW; Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway. mohammedzimmo1983@gmail.com.; The Intervention Centre, Oslo University Hospital, Oslo, Norway. mohammedzimmo1983@gmail.com.; Department of Obstetrics and Gynecology, Al Shifa Hospitals, Gaza, Palestine. mohammedzimmo1983@gmail.com., Laine K; Institute for Clinical Medicine, University of Oslo, Oslo, Norway.; Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway., Hassan S; Faculty of Nursing, Pharmacy and Health Professions and Institute of Community and Public Health, Birzeit University, Ramallah, Palestine., Bottcher B; Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine., Fosse E; The Intervention Centre, Oslo University Hospital, Oslo, Norway., Ali-Masri H; Intervention Centre, Oslo University Hospital Rikshospitalet, Oslo, Norway.; Obstetrics Department, Palestine Medical complex, Ramallah, Palestine., Zimmo K; The Intervention Centre, Oslo University Hospital, Oslo, Norway.; Department of Obstetrics and Gynecology, Al Aqsa Hospital, Gaza, Palestine., Falk RS; Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway., Lieng M; Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.; Department of Gynecology, Oslo University Hospital, Oslo, Norway., Vikanes A; The Intervention Centre, Oslo University Hospital, Oslo, Norway.
Jazyk: angličtina
Zdroj: BMC pregnancy and childbirth [BMC Pregnancy Childbirth] 2022 Dec 02; Vol. 22 (1), pp. 892. Date of Electronic Publication: 2022 Dec 02.
DOI: 10.1186/s12884-022-05196-8
Abstrakt: Background: Caesarean section rates are rising globally. No specific caesarian section rate at either country-level or hospital-level was recommended. In Palestinian government hospitals, nearly one-fourth of all births were caesarean sections, ranging from 14.5 to 35.6%. Our aim was to assess whether variation in odds for intrapartum caesarean section in six Palestinian government hospitals can be explained by differences in indications.
Methods: Data on maternal and fetal health were collected prospectively for all women scheduled for vaginal delivery during the period from 1st March 2015 to 30th November 2016 in six government hospitals in Palestine. Comparisons of proportions in sociodemographic, antenatal obstetric characteristics and indications by the hospital were tested by χ2 test and differences in means by one-way ANOVA analysis. The odds for intrapartum caesarean section were estimated by logistic regression. The amount of explained variance was estimated by Nagelkerke R square.
Results: Out of 51,041 women, 4724 (9.3%) underwent intrapartum caesarean section. The prevalence of intrapartum caesarean section varied across hospitals; from 7.6 to 22.1% in nulliparous, and from 5.8 to 14.1% among parous women. The most common indications were fetal distress and failure to progress in nulliparous, and previous caesarean section with an additional obstetric indication among parous women. Adjusted ORs for intrapartum caesarean section among nulliparous women ranged from 0.42 (95% CI 0.31 to 0.57) to 2.41 (95% CI 1.70 to 3.40) compared to the reference hospital, and from 0.50 (95% CI 0.40-0.63) to 2.07 (95% CI 1.61 to 2.67) among parous women. Indications explained 58 and 66% of the variation in intrapartum caesarean section among nulliparous and parous women, respectively.
Conclusion: The differences in odds for intrapartum caesarean section among hospitals could not be fully explained by differences in indications. Further investigations on provider related factors as well as maternal and fetal outcomes in different hospitals are necessary.
(© 2022. The Author(s).)
Databáze: MEDLINE
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