Magnitude and Determinants of Primary Cesarean Section Among Women Who Gave Birth in Shire, Northern Ethiopia

Abstract

Background: Cesarean section (CS) is a lifesaving medical intervention. It plays a vital role in decreasing maternal mortality and morbidity rates. It is also an indicator of maternal health services quality of a country. CS practice has been rising regardless of the medical condition, age, race, or gestational age. However, it is associated with many complications compared with vaginal deliveries, particularly in developing countries. Therefore, the aim of this study was to assess the magnitude and determinants of primary cesarean section among women who gave birth in Suhul General Hospital, Shire town, Northern Ethiopia. Methods: Institutional cross-sectional study was conducted from September 19 to October 20, 2017, among women who gave birth between September and August 2016 in Suhul General Public Hospital. Data were entered into EPI Info version 7 and exported to SPSS version 25 for analysis. Bivariate and multivariate logistic regressions were examined to assess the association between outcome and independent variables. Finally, variables with p-value less than 0.05 on multivariate logistic regression analysis were considered as significantly associated. Results: The magnitude of primary CS was 20.2\%. The main indication for CS was non-reassuring fetal heartbeat pattern (NRFHRP) (32.2\%). Women who had been augmented were 3.14 times more likely to undergo primary CS than those who had not (adjusted odds ratio (AOR)= 3.14; 95\% CI: 1.49, 6.57). Women who had pregnancy-induced hypertension were 3.1 times more likely to undergo primary CS than those who had not (AOR= 3.10; 95\% CI: 1.23, 7.83). Additionally, women who gave birth of >= 4000 gm newborns were 11 times (AOR= 11; 95\% CI: 2.30, 57.51) more likely to undergo primary CS than those who gave birth 2500-3999 gm of newborns. Moreover, women with unknown gestational age were 5.83 times (AOR= 5.83; 95\% CI: 2.37, 14.31) more likely to undergo primary CS than women whose gestational age was 37-42 weeks. Conclusion: The magnitude of the primary cesarean section in this study was high. Gestational age, augmentations, PIH, and birth weight were significant determinants of primary CS. Objective decisions should be practiced to reduce the magnitude of the primary caesarean section.