Abstract
Cesarean section rates remain high in Georgia. As a cesarean section in the first pregnancy generally lead to a cesarean section in subsequent pregnancies, primiparous women should be targeted for prevention strategies. The aim of the study was to assess factors associated with cesarean section among primiparous women. The study comprised 17,065 primiparous women with singleton, cephalic deliveries at 37–43 weeks of gestation registered in the Georgian Birth Registry in 2017. The main outcome was cesarean section. Descriptive statistics and logistic regression analysis were used to identify factors associated with cesarean section. The proportion of cesarean section was 37.1% with regional variations from 14.2% to 57.4%. Increased maternal age, obesity and having a baby weighing ≥4000 g were all associated with higher odds of cesarean section. Of serious concern for newborn wellbeing is the high proportion of cesarean section at 37–38 weeks of gestation. Further research should focus on organizational and economical aspects of maternity care to uncover the underlying causes of the high cesarean section rate in Georgia.
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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 Med 2018;15;e1002494.
Katikireddi SV, Gorman DR, Leyland AH. A comparison of trends in caesarean section rates in former communist (transition) countries and other European countries. Eur J Public Health 2013;23;381–3.
Anda EE, Nedberg IH, Rylander C, Gamkrelidze A, Turdziladze A, Skjeldestad FE, et al. Implementing a birth registry in a developing country – experiences from Georgia. Tidsskr Nor Laegeforen 2017;138;7–12 [Article in En, Norwegian].
Ministry of Health. Universal healthcare state programs – Ordinance N36. Tbilisi, Georgia: Government of Georgia; 2013.
Yisma E, Smithers LG, Lynch JW, Mol BW. Cesarean section in Ethiopia: prevalence and sociodemographic characteristics. J Matern Fetal Neonatal Med 2019;32;1130–5.
Begum T, Rahman A, Nababan H, Hoque DME, Khan AF, Ali T, et al. Indications and determinants of caesarean section delivery: evidence from a population-based study in Matlab, Bangladesh. PLoS One 2017;12;e0188074.
Miller S, Abalos E, Chamillard M, Ciapponi A, Colaci D, Comandé D, et al. Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. Lancet 2016;388;2176–92.
Mossialos E, Allin S, Karras K, Davaki K. An investigation of Caesarean sections in three Greek hospitals: the impact of financial incentives and convenience. Eur J Public Health 2005;15;288–95.
Zwecker P, Azoulay L, Abenhaim HA. Effect of fear of litigation on obstetric care: a nationwide analysis on obstetric practice. Am J Perinatol 2011;28;277–84.
Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 2016;4;CD004667.
Hoxha I, Syrogiannouli L, Luta X, Tal K, Goodman DC, da Costa BR, et al. Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis. BMJ Open 2017;7;e013670.
Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol 2012;120;1181–93.
WHO Reproductive Health Library. WHO recommendation on group antenatal care. Geneva, Switzerland: World Health Organization; 2016. Available from: https://extranet.who.int/rhl/topics/improving-health-system-performance/who-recommendation-antenatal-care-contact-schedules (accessed June 8, 2020).
Hosmer DW, Lemeshow S. Logistic regression. In: Veierød MB, Lydersen S, Laake P, editors. Medical statistics in clinical and epidemiological research. Oslo: Gyldendal Akademisk; 2012, pp. 90–126.
Ludford I, Scheil W, Tucker G, Grivell R. Pregnancy outcomes for nulliparous women of advanced maternal age in South Australia, 1998–2008. Aust N Z J Obstet Gynaecol 2012;52;235–41.
Bayrampour H, Heaman M. Advanced maternal age and the risk of cesarean birth: a systematic review. Birth 2010;37;219–26.
Rahman MM, Abe SK, Kanda M, Narita S, Rahman MS, Bilano V, et al. Maternal body mass index and risk of birth and maternal health outcomes in low- and middle-income countries: a systematic review and meta-analysis. Obes Rev 2015;16;758–70.
Gilead R, Yaniv Salem S, Sergienko R, Sheiner E. Maternal “isolated” obesity and obstetric complications. J Matern Fetal Neonatal Med 2012;25;2579–82.
Ebbing M. Fødsler i Norge 1967–2016 – noen nøkkeltall. [Births in Norway 1967–2016 – some key figures]. Norsk Epidemiologi 2017;27;9–12.
Meyer HE, Bøhler L, Vollrath M. Overweight and obesity in Norway. Oslo: Norwegian Public Health Institute; 2017. Available from: https://www.fhi.no/en/op/hin/lifestyle/overweight-and-obesity-in-norway---/#about-the-article (accessed October 4, 2019).
Boerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, Juan L, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet 2018;392;1341–8.
Cammu H, Martens G, Keirse MJNC. Mothers’ level of education and childbirth interventions: a population-based study in Flanders, Northern Belgium. Birth 2011;38;191–9.
Richards JL, Kramer MS, Deb-Rinker P, Rouleau J, Mortensen L, Gissler M, et al. Temporal trends in late preterm and early term birth rates in 6 high-income countries in North America and Europe and association with clinician-initiated obstetric interventions. JAMA 2016;316;410–19.
do Carmo Leal M, Esteves-Pereira AP, Nakamura-Pereira M, Domingues RMSM, Dias MAB, Moreira ME, et al. Burden of early-term birth on adverse infant outcomes: a population-based cohort study in Brazil. BMJ Open 2017;7;e017789.
Hanley GE, Janssen PA, Greyson D. Regional variation in the cesarean delivery and assisted vaginal delivery rates. Obstet Gynecol 2010;115;1201–8.
Khan MN, Islam MM, Shariff AA, Alam MM, Rahman MM. Socio-demographic predictors and average annual rates of caesarean section in Bangladesh between 2004 and 2014. PLoS One 2017;12;e0177579.
Long Q, Kempas T, Madede T, Klemetti R, Hemminki E. Caesarean section rates in Mozambique. BMC Pregnancy Childbirth 2015;15;253.
Brocklehurst P, Hardy P, Hollowell J, Linsell L, Macfarlane A, McCourt C, et al. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011;343;d7400.
Singh P, Hashmi G, Swain PK. High prevalence of cesarean section births in private sector health facilities- analysis of district level household survey-4 (DLHS-4) of India. BMC Public Health 2018;18;613.
Euro-Peristat Project. European Perinatal Health Report. Health and care of pregnant women and babies in Europe in 2010. 2013. Available from: https://www.europeristat.com/images/doc/EPHR2010_w_disclaimer.pdf (accessed November 20, 2019).
Euro-Peristat Project. European Perinatal Health Report. Core indicators of the health and care of pregnant women and babies in Europe in 2015. 2018. Available from: https://www.europeristat.com/images/EPHR2015_web_hyperlinked_Euro-Peristat.pdf (accessed May 14, 2019).
General Data Protection Regulation. Art. 5 GDPR – Principles relating to processing of personal data. 2016. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:32016R0679&rid=3#d1e40-1-1.
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Data availability statement: The data that support the findings of this study are available from National Centre for Disease Control & Public Health in Tbilisi, Georgia, but restrictions apply to the availability of these data, which were used under license for the current study. The data are not publicly available. Data are however available from the authors upon reasonable request and with permission of National Centre for Disease Control & Public Health in Georgia.
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Nedberg, I.H., Rylander, C., Skjeldestad, F.E. et al. Factors Associated with Cesarean Section among Primiparous Women in Georgia: A Registry-based Study. J Epidemiol Glob Health 10, 337–343 (2020). https://doi.org/10.2991/jegh.k.200813.001
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DOI: https://doi.org/10.2991/jegh.k.200813.001