A Retrospective Cohort Study of Pregnant Women in Labor at Kediri 1 Public Healthcare Center, Tabanan, Bali, Indonesia: A Focused Discussion on the Increasing Trends in Cesarean Section Deliveries

I Gde Sastra  Winata; Fenyta Christyani Christyani; I Wayan Agus Surya  Pradnyana; Mirani Ulfa  Yusrika; I Gusti Bagus Mulia Agung  Pradnyaandara; Putu Agung Satvika  Pradnyadevi; Ni Nengah Devianti Wulan  Pradnyani; Ni Putu  Widiyanti

doi:10.3889/oamjms.2024.11947

Authors

I Gde Sastra Winata Department of Obstetrics and Gynaecology Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
Fenyta Christyani Christyani Department of Obstetrics and Gynaecology Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
I Wayan Agus Surya Pradnyana Bachelor of Medicine, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
Mirani Ulfa Yusrika Bachelor of Medicine, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
I Gusti Bagus Mulia Agung Pradnyaandara Bachelor of Medicine, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
Putu Agung Satvika Pradnyadevi Bachelor of Medicine, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
Ni Nengah Devianti Wulan Pradnyani Bachelor of Medicine, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
Ni Putu Widiyanti The Head of Kediri 1 Public Healthcare Center, Tabanan, Bali, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2024.11947

Keywords:

cesarean section, risk factors, maternal care

Abstract

OBJECTIVE: The cesarean section (CS) is a surgical procedure in obstetrics that serves to protect the health and safety of both mothers and infants during labor process. Nevertheless, its prevalence has increased significantly in recent times. As such, this study aims to examine potential risk factors of expectant mothers in labor in Kediri 1 Public Healthcare Center, Tabanan, Bali, Indonesia.

METHODS: A retrospective cohort study was carried out on 848 pregnant women who received antenatal care at Kediri 1 Public Healthcare Center in Tabanan. The study followed up on electronic cohorts and medical records to determine the birth outcomes. Univariate and multivariate analyses were conducted using SPSS statistical software version 27 to determine the relative risk (RR).

RESULT: Most of women in labor are between 20-33 years old (75.4%) with mean age of 28.6 + 5.6. CS was the most common delivery method (67.9%), with obstetric indications being the most frequent reason (60.3%). Among these obstetric indications, LMR was the most common reason (49.3%). The study also revealed that maternal age and BMI were independent risk factors for CS aRR 1.89, 95% CI (1.19-2.99) p = 0.007 and aRR 2.18, 95% CI (1.01-4.70) p = 0.045, respectively. Additionally, maternal height was identified as a risk factor for CPD with an aRR of 8.39, 95% CI (2.36-29.8) p = 0.001.

CONCLUSION: Several factors have led to the growing acceptance of cesarean sections, including scientific advancements, social and cultural transformations, and medicolegal considerations. However, it should be noted that this procedure entails risks for both the mother and the child, and therefore should only be carried out when it is deemed necessary and beneficial.

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References

Zahroh RI, Disney G, Betrán AP, Bohren MA. Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987-2017. BMJ global health. 2020 Dec 1;5(12):e003844 https://doi.org/10.1136/bmjgh-2020-003844 PMid:33380412 PMCid:PMC7780721 DOI: https://doi.org/10.1136/bmjgh-2020-003844

Ye J, Betrán AP, Guerrero Vela M, Souza JP, Zhang J. Searching for the optimal rate of medically necessary cesarean delivery. Birth. 2014;41(3):237-44. https://doi.org/10.1111/birt.12104 PMid:24720614 DOI: https://doi.org/10.1111/birt.12104

Adewuyi EO, Auta A, Khanal V, Tapshak SJ, Zhao Y. Cesarean delivery in Nigeria: prevalence and associated factors-a population-based cross-sectional study. BMJ open. 2019 Jun 1;9(6):e027273. https://doi.org/10.1136/bmjopen-2018-027273 PMid:31213450 PMCid:PMC6596937 DOI: https://doi.org/10.1136/bmjopen-2018-027273

Timor-Tritsch IE, Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: Early placenta accreta and cesarean scar pregnancy. A Review. American Journal of Obstetrics and Gynecology. 2012 Jul;207(1):14-29. https://doi.org/10.1016/j.ajog.2012.03.007 PMid:22516620 DOI: https://doi.org/10.1016/j.ajog.2012.03.007

Sandall J, Tribe RM, Avery L, Mola G, Visser GH, Homer CS, et al. Short-term and long-term effects of caesarean section on the health of women and children. The Lancet. 2018 Oct;392(10155):1349-57. https://doi.org/10.1016/S0140-6736(18)31930-5 PMid:30322585 DOI: https://doi.org/10.1016/S0140-6736(18)31930-5

Bateman BT, Bansil P, Hernandez-Diaz S, Mhyre JM, Callaghan WM, Kuklina EV. Prevalence, trends, and outcomes of chronic hypertension: A nationwide sample of delivery admissions. American Journal of Obstetrics and Gynecology. 2012 Feb;206(2):134.e1-134.38. https://doi.org/10.1016/j.ajog.2011.10.878 PMid:22177190 PMCid:PMC4103984 DOI: https://doi.org/10.1016/j.ajog.2011.10.878

Grobman WA, Bailit JL, Rice MM, Wapner RJ, Reddy UM, Varner MW, et al. Frequency of and factors associated with severe maternal morbidity. Obstetrics & Gynecology. 2014;123(4):804-10. https://doi.org/10.1097/AOG.0000000000000173 PMid:24785608 PMCid:PMC4116103 DOI: https://doi.org/10.1097/AOG.0000000000000173

Leonard SA, Main EK, Carmichael SL. The contribution of maternal characteristics and cesarean delivery to an increasing trend of severe maternal morbidity. BMC Pregnancy and Childbirth. 2019 Jan 9;19:1-9. https://doi.org/10.1186/s12884-018-2169-3 PMid:30626349 PMCid:PMC6327483 DOI: https://doi.org/10.1186/s12884-018-2169-3

WHO. WHO statement on caesarean section rates. Geneva: WHO, 2019. http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/

Agency of Health Research and Development (Indonesia). Basic Health Research 2018.

Sungkar A, Basrowi RW. Rising trends and indication of caesarean section in Indonesia. World Nutrition Journal. 2020;4(S2):1-7. https://doi.org/10.25220/WNJ.V04.S2.0001 DOI: https://doi.org/10.25220/WNJ.V04.S2.0001

Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS medicine. 2018 Jan 23;15(1):e1002494. https://doi.org/10.1371/journal.pmed.1002494 PMid:29360829 PMCid:PMC5779640 DOI: https://doi.org/10.1371/journal.pmed.1002494

Verma V, Vishwakarma RK, Nath DC, Khan HT, Prakash R, Abid O. Prevalence and determinants of caesarean section in South and South-East Asian women. PloS one. 2020 Mar 12;15(3):e0229906. https://doi.org/10.1371/journal.pone.0229906 PMid:32163440 PMCid:PMC7067459 DOI: https://doi.org/10.1371/journal.pone.0229906

Torloni MR, Betrán AP, Montilla P, Scolaro E, Seuc A, Mazzoni A, Althabe F, Merzagora F, Donzelli GP, Merialdi M. Do Italian women prefer cesarean section? Results from a survey on mode of delivery preferences. BMC pregnancy and childbirth. 2013 Dec;13:1-8. https://doi.org/10.1186/1471-2393-13-78 PMid:23530472 PMCid:PMC3621281 DOI: https://doi.org/10.1186/1471-2393-13-78

O'Donovan C, O'Donovan J. Why do women request an elective cesarean delivery for non‐medical reasons? A systematic review of the qualitative literature. Birth. 2017;45(2):109-19. https://doi.org/10.1111/birt.12319 PMid:29105822 DOI: https://doi.org/10.1111/birt.12319

Neuman M, Alcock G, Azad K, Kuddus A, Osrin D, More NS, Nair N, Tripathy P, Sikorski C, Saville N, Sen A. Prevalence and determinants of caesarean section in private and public health facilities in underserved South Asian communities: cross-sectional analysis of data from Bangladesh, India and Nepal. BMJ open. 2014 Dec 1;4(12):e005982. https://doi.org/10.1136/bmjopen-2014-005982 DOI: https://doi.org/10.1136/bmjopen-2014-005982

PMid:25550293 PMCid:PMC4283435

Litorp H, Mgaya A, Mbekenga CK, Kidanto HL, Johnsdotter S, Essén B. Fear, blame and transparency: Obstetric caregivers' rationales for high caesarean section rates in a low-resource setting. Social Science & Medicine. 2015;143:232-40. https://doi.org/10.1016/j.socscimed.2015.09.003 PMid:26364010 DOI: https://doi.org/10.1016/j.socscimed.2015.09.003

Begum T, Ellis C, Sarker M, Rostoker JF, Rahman A, Anwar I, Reichenbach L. A qualitative study to explore the attitudes of women and obstetricians towards caesarean delivery in rural Bangladesh. BMC pregnancy and childbirth. 2018 Dec;18:1-1. https://doi.org/10.1186/s12884-018-1993-9 PMid:30208874 PMCid:PMC6134512 DOI: https://doi.org/10.1186/s12884-018-1993-9

Räisänen S, Gissler M, Kramer MR, Heinonen S. Influence of delivery characteristics and socioeconomic status on giving birth by caesarean section-a cross sectional study during 2000-2010 in Finland. BMC pregnancy and childbirth. 2014 Dec;14:1-9. https://doi.org/10.1186/1471-2393-14-120 PMid:24678806 PMCid:PMC3999387 DOI: https://doi.org/10.1186/1471-2393-14-120

Kumar P, Dhillon P. Household- and community-level determinants of low-risk caesarean deliveries among women in India. Journal of Biosocial Science. 2020;53(1):55-70. https://doi.org/10.1017/S0021932020000024 PMid:31997731 DOI: https://doi.org/10.1017/S0021932020000024

Menteri Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 3 Tahun 2020 Tentang Klasifikasi dan Perizinan Rumah Sakit. 2020

Kumar P, Srivastava S, Chaudhary P, Muhammad T. Factors contributing to socio-economic inequality in utilization of caesarean section delivery among women in Indonesia: Evidence from Demographic and Health Survey. Plos one. 2023 Sep 13;18(9):e0291485. https://doi.org/10.1371/journal.pone.0291485 PMid:37703256 PMCid:PMC10499255 DOI: https://doi.org/10.1371/journal.pone.0291485

Amjad A, Amjad U, Zakar R, Usman A, Zakar MZ, Fischer F. Factors associated with caesarean deliveries among child-bearing women in Pakistan: secondary analysis of data from the demographic and health survey, 2012-13. BMC pregnancy and childbirth. 2018 Dec;18:1-9. https://doi.org/10.1186/s12884-018-1743-z PMid:29685129 PMCid:PMC5914047 DOI: https://doi.org/10.1186/s12884-018-1743-z

Rydahl E, Declercq E, Juhl M, Maimburg RD. Cesarean section on a rise-Does advanced maternal age explain the increase? A population register-based study. PloS one. 2019 Jan 24;14(1):e0210655. https://doi.org/10.1371/journal.pone.0210655 PMid:30677047 PMCid:PMC6345458 DOI: https://doi.org/10.1371/journal.pone.0210655

Hofmeyr GJ, Barrett JF, Crowther CA. Planned caesarean section for women with a twin pregnancy. Cochrane Database of Systematic Reviews. 2015;(12). https://doi.org/10.1002/14651858.CD006553.pub3 PMid:26684389 PMCid:PMC6507501 DOI: https://doi.org/10.1002/14651858.CD006553.pub3

Bohlmann MK, Luedders DW, Beyer D, Kavallaris A, Baumann K, Diedrich K, et al. NULLIPAROUS patients with small stature delivering at term have an increased risk of secondary cesarean section. Archives of Gynecology and Obstetrics. 2009;282(3):241-4. https://doi.org/10.1007/s00404-009-1216-8 PMid:19714346 DOI: https://doi.org/10.1007/s00404-009-1216-8

Yu Z, Han S, Zhu J, Sun X, Ji C, Guo X. Pre-pregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: a systematic review and meta-analysis. PloS one. 2013 Apr 16;8(4):e61627. https://doi.org/10.1371/journal.pone.0061627 PMid:23613888 PMCid:PMC3628788 DOI: https://doi.org/10.1371/journal.pone.0061627

Roldán E, Grajeda LM, Pérez W. Maternal height associated with cesarean section. A cross-sectional study using the 2014-2015 national maternal-child health survey in Guatemala. International journal for equity in health. 2020 Dec;19:1-9. https://doi.org/10.1186/s12939-020-01182-8 PMid:32731894 PMCid:PMC7393904 DOI: https://doi.org/10.1186/s12939-020-01182-8