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Table 3 Individual and institutional factors associated with elective, emergency and intrapartum caesarean sections (CS). Multivariable analysis £

From: Individual and institutional determinants of caesarean section in referral hospitals in Senegal and Mali: a cross-sectional epidemiological survey

Women characteristics

 

Adjusted OR (95% CI)

 
 

Elective CS (n=83 122)

Emergency CS (n=85 737)

Intrapartum CS (n=81 040)

Age ≥35 years (vs. <35 years)

1.9 (1.7-2.2)

1.3 (1.2-1.5)

1.2 (1.1-1.3)

Multiple pregnancy (vs. singleton)

2.1 (1.7-2.6)

1.3 (1.1-1.6)

1.6 (1.5-1.8)

Nulliparous (vs. multiparous)

1.6 (1.4-1.8)

1.6 (1.5-1.8)

1.8 (1.7-1.8)

Previous caesarean section

19.2 (17.2-21.6)

5.5 (4.8-6.2)

8.9 (8.3-9.6)

Hypertensive disorders §

2.2 (1.8-2.6)

7.7 (6.9-8.6)

1.1 (1.0-1.2)

Vaginal bleeding (near full term)

 

10.2 (8.9-11.6)

2.0 (1.8-2.2)

Premature rupture of membranes

 

3.9 (3.4-4.5)

2.2 (2.0-2.4)

Suspected cephalopelvic-disproportion

  

2.8 (2.0-4.0)

Referred from another facility

 

1.5 (1.3-1.6)

5.7 (5.4-6.0)

Oxytocin use

  

0.3 (0.3-0.4)

Premature labour

  

0.2 (0.2-0.3)

Suspected intrauterine death

  

0.3 (0.3-0.4)

Hospital characteristics

   

Senegal (vs. Mali)

 

3.9 (2.6-6.1)

0.5 (0.4-0.7)

Adult intensive-care unit available

 

2.3 (1.5-3.5)

 

Newborn care unit with incubators

1.6 (1.2-2.2)

  

Neonatal resuscitation

1.7 (1.2-2.4)

  

Medical staff configuration*

   

Level I

1

1

1

Level II

2.0 (1.0-4.1)

0.9 (0.4-1.9)

0.9 (0.6-1.4)

Level III

4.8 (2.6-8.8)

1.5 (0.7-3.2)

1.0 (0.7-1.3)

Level IV

9.4 (5.1-17.1)

1.5 (0.7-3.5)

1.1 (0.8-1.6)

Anaesthetist 24h/day in hospital

 

2.7 (1.8-4.0)

 
  1. OR, Odd’s ratio; CI, confidence interval.
  2. £ The analyses were conducted using logistic mixed models adjusted for the period. In the first model, elective CS were compared with all deliveries with a trial of labour; the institutional variables that were not included in the final model after a forward-stepwise procedure were: country, generator, adult intensive care unit, ultrasound services, urine culture, proteinuria, electronic foetal monitoring, anaesthetist 24h/day in hospital, maternal cardio-pulmonary resuscitation, at least one pediatrician and annual number of deliveries. In the second model, emergency CS were compared with all other deliveries; the institutional variables that were not included in the final model after a forward-stepwise procedure were: generator, proteinuria, glucose-tolerance test, urine culture, electronic foetal monitoring, neonatal resuscitation and maternal cardio-pulmonary resuscitation. In the third model, intrapartum CS were compared with all vaginal deliveries; the institutional variables that were not included in the final model after a forward-stepwise procedure were: high-risk consultation clinic, urine culture and at least one resident MD in training § Chronic hypertension, gestational hypertension, pre-eclampsia, eclampsia, HELLP syndrome; * Level I: Trained general practitioner, nurse-anaesthetist, ≤2 midwives; Level II: trained general practitioner, nurse-anaesthetist, ≥3 midwives; Level III: obstetrics specialist, nurseanaesthetist, ≥3 midwives; Level IV: obstetrics specialist, medical anaesthetist, ≥3 midwives.
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BMC Pregnancy and Childbirth

ISSN: 1471-2393

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