Modeling of Associated Factors that A ffect the M ethod of Pregnancy Termination

Document Type : Original Article

Authors

1 M.Sc. of Epidemiology, Faculty of Health and Paramedical Sciences, Arak University of Medical Sciences, Arak, Iran

2 M.Sc. in Epidemiology, Arak University of Medical Sciences, Arak, Iran

Abstract

Introduction: Cesarean section is the surgical delivery of a fetus, placenta, and the membranes through an incision in the mother's abdomen and uterus. Nowadays about 50-65% of all deliveries in our country are being done using this method. So we aimed to identify the factors that affect the method of delivery.
 
Methods and Material: This study was done on 414 pregnant women referred to public and privative hospitals in Shiraz from1384 To 1385 Data regarding the mothers’ demography, history of previous deliveries, fetuses’ presentations, and neonates’ physical examinations were collected using a structured questionnaire and interview as well as using the medical records. The data were then analyzed using SPSS software version 13. Fisher exact test, independent t test, and multiple regression test were used to compare two groups.
 
Results: The overall prevalence of performing cesarean section was 66.4%, which were 89% and 63.28% for privative and public hospitals respectively. Age, height, body mass index, socioeconomic status, nulliparity, admissions to privative hospitals, history of previous cesarean section, pharmacologic induction of labor, macrosomia, shoulder dystocia, and breach presentation showed a significant correlation with cesarean section (P<0.05). In regression model, history of previous cesarean section, mothers’ age> 35 years, and the level of mothers’ education were the most important factors that were accompanied by performing cesarean section as the method of delivery.
 
Conclusion: Cesarean section is known as the recommended method of delivery in some specific emergency situations. However its prevalence is increasing because of economical benefits for physicians as well as mothers’ fear from labor pain. So persuading mothers especially the nulliparous ones to vaginal delivery is essential to decrease the related side effects and the rate of cesarean section in the following pregnancies.

Keywords


1. Farr SL, Jamieson DJ, Rivera HV, Ahmed Y, Heilig CM. Risk factors for cesarean delivery
among Puerto Rican women. Obstet Gynecol 2007 Jun;109(6):1351-7
2. Cuningham FG, Leveno KJ, Bloome SL, Hauth JC, Gilstrap LC,Wenstrom KD. Williams
obstetrics. ,22nd
 ed. New York:McGraw-Hill;2005:865-6.
3. Cnattingius R, Cnattingius S, Notzon FC. Obstacles to reducing cesarean rates in a lowcesarean
setting: the effect of maternal age, height and weight. Obstet Gynecol.1998
Oct;;92(4 Pt 1):501-6.
4. Ganji F, Raeisi R, Khosravi SA, Soltani P, Kasiri KA, Jafar Zadeh L, et al. [Effect of a
participatory intervention to reduce the number of unnecessary cesarean sections performed
in Shahrekord] [Article in Farsi]. Shahrekord Univ Med Sci J 2006;(8):18-14.
5. Poma PA. Effect of departmental policies on cesarean delivery rates: a community hospital
experience. Obstet Gynecol . 1998 Jun;91(6):1013-8..
6. Cuningham FG, Leveno KJ, Bloome SL, Hauth JC, Gilstrap LC,Wenstrom KD. Williams
obstetrics. ,22nd
 ed. New York:McGraw-Hill;2005;537-64.
7. Wilkinson C, McIlwaine G, Boulton-Jones C, Cole S. Is a rising caesarean section rate
inevitable?. Br J Obstet Gynaecol. 1998 Jan;105(1): 45-52.
8. Fabri RH, Murta EFC. Social issues in reproductive medicine. Socioeconomic factors and
cesarean section rates. Int J Gynecol Obstet 2002;76:87-8 .
9. Lukanova M, Popov I. [Effect of some factors on obstetrical care of women with previous
cesarean section]. Akush Ginekol (Sofiia) 2002;41(6):44-8.
10. Schuitemaker N, van Roosmalen J, Dekker G, van Dongen H, Gravenhorst JB. Maternal
mortality after cesarean section in The Netherlands. Acta Obstet Gynecol Scand 1997
Apr;76(4):332-4.
11. Hong X. Factors related to the high cesarean section rate and their effects on the "price
transparency policy" in Beijing, China. Tohoku J Exp Med 2007 Jul;212(3):283-98.
12. Wirakusmah FF. Maternal and prenatal mortality/morbidity associated with cesarean
section in Indonesia. J Obstet Gynecol 1995 Oct;21(5):475-81.
13. Cuningham FG, Leveno KJ, Bloome SL, Hauth JC, Gilstrap LC,Wenstrom KD. Williams
obstetrics. ,22nd
 ed. New York:McGraw-Hill;2005; 591-4.
14. Belizian JM, Althable F, Barros FC, Alexander S. Rates and implications of caesarean
sections in Latin America: ecological study. BMJ 1999 Nov;319(7222):1397-400.
15. Hannah ME. Planned elective cesarean section: a reasonable choice for some women?.
CMAJ 2004 Mar 2;170(5):813-4..
16. Mobaraki A, Zadeh Bagheri Gh, Zandi Ghashghaei K. [Prevalence of cesarean section and
the related causes in Yasuj city in 2003] [Article in Farsi]. Armaghane–Danesh (J Yasuj
Univ Med Sci) 2005;39(10):65-72.
17. Afshari S, Dastfan F, Vaziri ES, Tashakhori SA. [Investigating the abundance of natural
parturition, cesarean and related causes in public and private centers of Khorasan] [Article
in Farsi]. Iranian J Obstet Gyn Infertil 1999;1(1):40-45.
18. Piri S, Kiani A. [Survey on the prevalence and reasons of different types of delivery and the
effect of demographic factors on it] [Article in Farsi]. Daneshvar: Sci Res Shahed
Univ 2001;35(8):7-14.
19. Moghareh Abed L, Goharian V, Ghanei M, Adibi P, Goharian AK.[Cesarean section rate
and its indications in Iran in 1998] [Article in Farsi]. Hakim Res J 2000;2(3):147-54.
20. Shariat M, Majlesi F, Azari S, Mahmoodi M. [Cesarean section in maternity hospitals in
Tehran] [Article in Farsi]. Payesh: J Iranian Inst Health Sci Res 2002;3(1):5-10. 
 
21. Alimohamadian M, Shariat M, Mahmoodi M, Ramezanzadeh F. [The influence of maternal
request on the elective cesarean section rate in maternity hospitals in Tehran] [Article in
Farsi]. Payesh: J Iranian Inst Health Sci Res 2003;2(2):133-39.
22. Hajian K. [The trend of cesarean section in public and private centers of Babol, 1994-99]
[Article in Farsi]. J Shahid Beheshti Univ Med Sci Health Serv 2002;3(26):175-79.
23. Shakerian B. [Prevalence and causes of cesarean section in Chaharmahal & Bakhtiary in
2002] [Article in Farsi]. Shahrekord Univ Med Sci J 2004;1(6):63-9.