English abstract
The number of women having babies born by cesarean section is growing rapidly in both the developed and developing countries. Likewise the cesarean section rate has increased gradually in Oman. We conducted a hospital based case-control study in order to describe the epidemiology of cesarean section and to ascertain the main Obstetric and non-obstetric risk factors of cesarean section in Oman. Moreover, we aim to measure the degree and extent of association between cesarean section and the leading risk factors in term of bivariate as well as multivariate and to study the neonatal outcomes of cesarean section. We used a hospital based case-control study of 250 cases and 250 controls. The cases represent those women who delivered through cesarean section deliveries and the controls represent those women who delivered through vaginal deliveries. The information was collected from maternity health green card and through face to face interviews. We used Chi-square test and odd ratio to assess the association between cesarean section and various characteristics under study with P-value less than or equal to 0.05 as a significant level of association. We have used also logistic regression to adjust for confounding factors and for multivariate analysis. The results of crude analysis of the study showed that among demographic risk factors age 40) (OR=3.01, 95% CI 1.10, 8.22), education (graduate and above) (OR=2.55, 95% CI 1.06, 6.13), high family income (> 1000 R.O) (OR=2.00, 95% CI 1.05, 3.81) were positively associated with the experience of cesarean section delivery. Among medical conditions complicating pregnancy, only gestational diabetes (OR=2.05, 95% CI 1.21, 3.50), having one or more previous cesarean section (OR=9.93, 95% CI 5.55, 15.71), abnormal fetal presentations were positively associated with the experience of cesarean delivery. Among contraceptive methods used by women only past used of IUCD method (OR=3.10, 95% CI 1.07, 8.99) was positively associated with the experience of cesarean section. Among physical activities of women, body mass index (obesity) (OR= 2.95, 95% CI 1.61, 5.39) dissatisfaction of body fitness (OR=1.65, 95% CI 1.14, 2.40) and a negative attitude toward exercise prevention from cesarean sections (women who did not think that exercise prevents from experiencing cesarean delivery) (OR=4.38, 95% CI 2.55, 7.55) were positively associated with cesarean section. Among health management variables, delivery time (7:00 am - 2:00 pm) (OR=2.39, 95% CI 1.65, 3.48), gestational age (<38 weeks) (OR=2.05, 95% CI 1.34, 3.13) and extremes of neonates birth weight(<2.50 kg and > 4.00 kg) (OR= 1.77, 95% CI 1.15, 2.7.4, OR=5.86, 95% CI 1.27, 27.09 respectively) were positively associated with cesarean section delivery.
After adjustment for education and parity as confounding factors of association between cesarean section and age, age (40) was still positively associated with the experience of cesarean section (OR=5.64, 95% CI 1.62, 19.60). After adjustment for age and parity as confounding factors of association between cesarean section and education, those women who had finished their college and above still had more risk to experience cesarean deliveries but the evidence of association became statistically not significant (OR= 1.79,95% CI 0.61, 5.27). After adjustment for age and education as confounding factors of association between cesarean section and parity, the increased parity was found to be associated with decreased risk of cesarean section delivery but the evidence of association was not statistically significant. After adjustment for age and education as confounding factors of association between cesarean section and family income, the evidence of association in general was significant and those women who had high family income still had increased risk of experience cesarean sections deliveries (OR=1.37,95% CI 0.66, 2.88). After we applied multivariate logistic regression ( backward step-wise ) for all risk factors under study, we conclude that age ( 40 years),pre-pregnancy diabetes, having one or more previous cesarean section delivery, abnormal fetal presentation, increased body mass index (obesity) and extremes of neonates birth weight (<2.50 kg and > 4.00 kg) were important predictor of cesarean section deliveries. Moreover we found that increased parity and past use of birth spacing methods other than intrauterine device were associated with decreased risk of cesarean section deliveries
