Incidence and correlates of cesarean section in a capital city of a middle-income country

Deliveries in Lebanon, the Country with the Highest Refugee Density in the World: A Descriptive Review

PURPOSE

The aim of this study is to analyze obstetrical and reproductive health parameters in Lebanon from 2015 until 2018 in the setting of the Syrian refugee influx in order to evaluate potential risks and provide a management plan to improve outcomes.

DESCRIPTION

Data from the Lebanese Ministry of Public Health (LMPH) on all obstetrical deliveries that occurred in Lebanon between 2015 and 2018 was screened and analyzed. Number and mode of delivery as well as maternal and neonatal outcomes were included. Joinpoint regression analysis was used for trends of selected parameters. Independent two-sample t-tests were used for comparisons.

ASSESSMENT

Women of non-Lebanese nationality residing in Lebanon had a significantly greater number of total deliveries (p-value < 0.001), vaginal deliveries (p-value = 0.002), cesarean sections (p-value = 0.02). When looking at delivery trends from 2015 to 2018, Lebanese women had a significant decrease in total number of deliveries (p-value < 0.001) and vaginal deliveries (p-value < 0.001).

CONCLUSION

Total number of deliveries and cesarean sections is on the rise in Lebanon. Cesarean section practice should be audited by the LMPH and the Lebanese Order of Physicians (LOP). Local and international agencies should prioritize the implementation and management of family planning facilities in refugee hosting countries.

Caesarean sections in teaching hospitals: systematic review and meta-analysis of hospitals in 22 countries

OBJECTIVE

The aim of this study is to determine the odds of caesarean section in all births in teaching hospitals as compared with non-teaching hospitals.

SETTING

Over 3600 teaching and non-teaching hospitals in 22 countries. We searched CINAHL, The Cochrane Library, PubMed, sciELO, Scopus and Web of Science from the beginning of records until May 2020.

PARTICIPANTS

Women at birth. Over 18.5 million births.

INTERVENTION

Caesarean section.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measures are the adjusted OR of caesarean section in a variety of teaching hospital comparisons. The secondary outcome is the crude OR of caesarean section in a variety of teaching hospital comparisons.

RESULTS

In adjusted analyses, we found that university hospitals have lower odds than non-teaching hospitals (OR=0.66, 95% CI 0.56 to 0.78) and other teaching hospitals (OR=0.46, 95% CI 0.24 to 0.89), and no significant difference with unspecified teaching status hospitals (OR=0.92, 95% CI 0.80 to 1.05, τ2=0.009). Other teaching hospitals had higher odds than non-teaching hospitals (OR=1.23, 95% CI 1.12 to 1.35). Comparison between unspecified teaching hospitals and non-teaching hospitals (OR=0.91, 95% CI 0.50 to 1.65, τ2=1.007) and unspecified hospitals (OR=0.95, 95% CI 0.76 to 1.20), τ2<0.001) showed no significant difference. While the main analysis in larger sized groups of analysed studies reveals no effect between hospitals, subgroup analyses show that teaching hospitals carry out fewer caesarean sections in several countries, for several study populations and population characteristics.

CONCLUSIONS

With smaller sample of participants and studies, in clearly defined hospitals categories under comparison, we see that university hospitals have lower odds for caesarean. With larger sample size and number of studies, as well as less clearly defined categories of hospitals, we see no significant difference in the likelihood of caesarean sections between teaching and non-teaching hospitals. Nevertheless, even in groups with no significant effect, teaching hospitals have a lower or higher likelihood of caesarean sections in several analysed subgroups. Therefore, we recommend a more precise examination of forces sustaining these trends.

PROSPERO REGISTRATION NUMBER

CRD42020158437.

Cesarean delivery rates in Saudi Arabia: a ten-year review

BACKGROUND AND OBJECTIVES

In view of the global increase in the rate of cesarean deliveries (CD), with the associated higher morbidity and mortality, this study was undertaken to review CD rates and some of their determinants over a ten-year period in Saudi Arabia.

METHODS

Maternity data for Ministry of Health (MOH) hospitals across 14 administrative regions and other governmental hospitals in nine clusters were collected and the corresponding rates calculated using MOH yearly statistical books from 1997 to 2006. No private hospital data are reported.

RESULTS

The overall CD rate significantly increased by 80.2% from 10.6% in 1997 to 19.1% in 2006. The greatest increase of 265% was in the Northern region and the least of 32.8% was in the Royal Commission Hospitals. Both vaginal breech and operative vaginal deliveries showed a significant decrease of 38% and 29%, respectively. There was a significant negative correlation between the increasing CD rate and the decreasing vaginal breech and operative vaginal deliveries rates. The volume of annual deliveries did not influence the CD rate.

CONCLUSIONS

A significant increase of more than 80% in the CD rate was observed from 1997 to 2006. A national strategy to reduce the CD rate is needed and will require upgrading of the existing vital registration system. We also recommend that current national data capturing mechanisms be expanded to include private sector data and to include indications for CD.