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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.