Factors leading to cesarean section delivery at Felegehiwot referral hospital, Northwest Ethiopia: a retrospective record review

Abebe et al. Reproductive Health (2016) 13:6 DOI 10.1186/s12978-015-0114-8 RESEARCH Open Access Factors leading to cesarean section delivery at Felegehiwot referral hospital, Northwest Ethiopia: a retrospective record review Fantu Eyowas Abebe1*, Abebaw Worku Gebeyehu2, Ashebir Negasi Kidane1 and Gizached Aynalem Eyassu3 Abstract Background: Cesarean section is the commonest obstetric operative procedure worldwide. When used appropriately cesarean sections can improve infant and/or maternal outcomes. However, when used inappropriately the potential harm may exceed the potential benefit of cesarean section. Appreciating the limited information in this area the current study assessed the rate and factors associated with cesarean section in Felegehiwot referral hospital, Bahir Dar, northwest Ethiopia. Method: The study was a retrospective analysis of eligible patient records that included 2967 pregnant women who had underwent either cesarean or vaginal delivery from July 1, 2012 to June 31, 2013. The data were double entered to EPI-INFO 3.5.2 and analyzed with SPSS. Binary logistic regression model was fitted to identify independent factors associated with cesarean section. Result: The proportion of women who underwent cesarean section in this study was 25.4 %. Obstructed labor (30.7 %), fetal distress (15.9 %) and abnormal presentation (13.4 %) were the major obstetric indications for cesarean section. The odd of undergoing cesarean section was higher among mothers in rural residence (AOR = 1.63, 95 % CI: 1.21, 2.20), mothers reported to have pregnancy risk factors (AOR = 2.31, 95 % CI: 1.74, 3.07) and lower among mothers in age category of 15–19 (AOR = 0.63, 95 % CI: 0.43, 0.93). Conclusion: Obstetric factors occurring around birth, including obstructed labor and fetal distress were the main reasons leading to Cesarean Section rather than background characteristics assumed to be a risk. The results imply that there is a need for timely and accurate screening of women during obstetric care and, decision to perform cesarean section should be based on clear, compelling and well-supported justifications. Keywords: Cesarean section, Retrospective record review, Ethiopia Background Cesarean section is the commonest obstetric operative procedure worldwide [1, 2]. When used appropriately Csections can improve infant and/or maternal outcomes. However, when used inappropriately the potential harm may exceed the potential benefit of C-section. C-sections cost more than vaginal births and can result in increased risk to mother and baby [2, 3]. There is a growing concern that Cesarean rates have been rising for all women in the world regardless of medical condition, age, race, or * Correspondence: 1 Strengthening Human Resource for Health Project, iNGO, P.O. Box, 1566 Bahir Dar, Ethiopia Full list of author information is available at the end of the article gestational age. International concern over such increases have prompted the World Health Organization to suggest that CS rates should not exceed 15 % [4], with some evidence indicating caesarean section rates above 15 % are not associated with additional reduction in maternal and neonatal mortality and morbidity [5, 6]. Modern obstetrics practice for medical, social, economic and legal reasons have witnessed an increase in the primary cesarean section rates everywhere [7–16]. While the Cesarean Section rate ranges between 12 and 86 % across studies done in developed countries [6, 7, 10, 17] and the rate in developing countries vary between 2 and 39 % [2, 4, 6, 12, 18, 19]. © 2016 Abebe et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Abebe et al. Reproductive Health (2016) 13:6 Caesarean section delivery is increasing in Ethiopia [20], indicative of access to obstetric care service in the country. In the urbanized region of the country, the rate ranges from 8 to 37 % [20, 21]. The increment in caesarean section delivery rate in major urban cities is a cause of concern as it surpasses the WHO threshold of 15 %. However, according to the Ethiopian demographic and health survey 2011 report, only 2 % of the women had undergone caesarean section [22]. Many factors have been claimed to attribute for increased cesarean section rate across the world. While some literatures [3, 4, 6, 14] reported Premature Rupture of the amniotic fluid Membrane (PROM), Cephalic Pelvic Disproportion (CPD), fetal distress, multiple pregnancy and breech presentation as factors associated with increased rate of caesarean section. Some others revealed that it is associated with place of health seeking (private with public) and maternal preferences [9, 20, 23, 24]. Few other studies also demonstrated the relationship between cesarean section and maternal age [9, 24, 25]. Even some other studies find out that, birth weight, parity, maternal height and history of antenatal care visit (ANC) to be factors associated with cesarean section [10, 17]. Ante Partum hemorrhage (APH), multiple pregnancy, cord prolapse, mothers HIV infection condition and having previous history of cesarean section were also found to be factors leading to increased cesarean section rate [12, 18, 19]. The improved safety of surgical and anesthetic skills in modern obstetrics and mothers positive attitudes towards CS among staff and patients could also be the other factors that contribute for increased rate of cesarean section. It has been shown that a significant number of obstetricians would agree to perform an elective CS without an obstetrical indication upon maternal request [9, 24, 26]. Currently there is much debate as to whether this surgical procedure should be performed for women without clear clinically acceptable indications [1, 6, 7]. Even, in Ethiopia, perhaps in the region little information is available with regard to the magnitude and factors associated with rate of C-section in hospitals. Thus, this study intended to assess the magnitude and factors associated with cesarean section in Felegehiwot Referral Hospital, Amara region, Northwest Ethiopia. Methods Study setting and design The study was a retrospective analysis of eligible and complete client records that included 2967 pregnant women who had undergone either cesarean or vaginal delivery from July 1, 2012 to June 31, 2013 in Felegehiwot Referral Hospital, Amhara region, Northwest Ethiopia. Page 2 of 7 This hospital is one of the five busiest referral hospitals in the (...truncated)