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Table 4 Odds ratios and adjusted odds ratios with 95% confidence intervals from mixed effects regression models of factors associated with adverse outcomes following intrapartum cesarean birth, WHOGS 2004–2008

From: Risk factors associated with adverse maternal outcomes following intrapartum cesarean birth: a secondary analysis of the WHO global survey on maternal and perinatal health, 2004–2008

  Univariate Analysis Multivariable Analysis
OR 95% CI P-value AOR 95% CI P-value
Woman-Level Factors
Human Development Index 2008 (ref: Lowa)    0.003    0.03
  Mediumb 0.05 (0.01, 0.46)   0.07 (0.01, 0.85)  
  Highc 0.01 (< 0.001, 0.16)   0.02 (0.001, 0.39)  
Antenatal Visits (ref: < 4)    <.0001    0.003
  4+ 0.46 (0.35, 0.59)   0.60 (0.43, 0.84)  
Medically high riskd (ref: No)    <.0001    0.0004
  Yes 2.17 (1.70, 2.77)   1.81 (1.30, 2.51)  
Age groups (ref: 19–34)    0.07    0.30
  0–18 1.00 (0.68, 1.46)   0.63 (0.35, 1.14)  
  35+ 1.39 (1.05, 1.84)   0.93 (0.65, 1.35)  
Education groups (ref: 13+)    <.0001    0.01
  0–6 1.82 (1.26, 2.63)   1.64 (1.03, 2.63)  
  7–12 0.97 (0.70, 1.34)   0.98 (0.66, 1.44)  
Marital status (ref: Single/Separated/Divorced/Widowed/Other)    0.79    0.61
  Married/Cohabitating 1.05 (0.75, 1.46)   0.88 (0.54, 1.44)  
BMI groups (ref: [18.5,25))    0.16    0.10
  [0,18.5) 2.47 (0.66, 9.18)   4.66 (1.12, 19.4)  
  [25,30) 1.17 (0.87, 1.56)   1.33 (0.95, 1.86)  
  30+ 1.42 (0.99, 2.04)   1.29 (0.84, 1.96)  
Obstetric & Labour-Level Factors
Obstetrically High Riske (ref: No)    <.0001    <.0001
  Yes 4.48 (3.50, 5.74)   3.67 (2.58, 5.23)  
Referred during labor (ref: No)    <.0001    0.08
  Yes 1.92 (1.47, 2.50)   1.37 (0.96, 1.96)  
Gestational Age at Birth (ref: 37–42)    <.0001    0.13
  24–33 5.16 (3.33, 8.00)   2.24 (0.96, 5.25)  
  34–36 2.82 (2.06, 3.87)   1.36 (0.82, 2.28)  
Birthweight (grams) (ref: [2500,3500))    <.0001    0.14
  < 1500 7.37 (4.33, 12.6)   1.64 (0.54, 4.97)  
  [1500,2500) 2.06 (1.52, 2.78)   0.97 (0.61, 1.54)  
  [3500–4500) 0.75 (0.59, 0.97)   0.72 (0.51, 1.00)  
  4500+ 1.70 (0.83, 3.47)   1.68 (0.68, 4.12)  
Onset of Labor (ref: Spontaneous)    0.71    0.68
  Induced 1.07 (0.75, 1.53)   0.91 (0.59, 1.42)  
Parity (ref: 0)    0.92    0.25
  1+ 1.01 (0.83, 1.24)   1.21 (0.88, 1.68)  
Fetal Presentation (ref: Cephalic)    0.15    0.04
  Breech 0.72 (0.52, 1.01)   0.52 (0.31, 0.87)  
  Other 0.89 (0.53, 1.50)   0.66 (0.31, 1.39)  
Number of neonates (ref: 1)    0.0002    0.24
  2+ 2.17 (1.44, 3.28)   1.46 (0.78, 2.76)  
Previous Cesarean (ref: No)    0.002    0.39
  Yes 0.66 (0.51, 0.86)   0.82 (0.53, 1.28)  
Available facility-Level Factors
Obstetrician Performed surgery (ref: No)    0.28    0.57
  Yes 0.84 (0.61, 1.15)   0.89 (0.59, 1.34)  
Teaching Facility (ref: No)    0.08    0.16
  Yes 0.37 (0.12, 1.14)   0.33 (0.07, 1.57)  
Total Deliveries at Facility (ref: < 3500)    0.27    0.26
  [3500,10,000) 2.21 (0.70, 7.01)   2.84 (0.64, 12.6)  
  10,000+ 3.65 (0.54, 24.8)   5.39 (0.43, 67.0)  
Urban Facility (ref: No)    0.16    0.26
  Yes 2.49 (0.70, 8.89)   2.89 (0.46, 18.3)  
Indication CS (ref: Elective)    <.0001    <.0001
  Fetal Indication 1.36 (0.84, 2.20)   1.31 (0.65, 2.64)  
  Failure to Progress/Dystocia 1.11 (0.69, 1.79)   1.39 (0.70, 2.76)  
  Maternal or Obstetric Indication 6.81 (4.25, 10.9)   4.74 (2.36, 9.50)  
  Multiples/Malpresentation 1.50 (0.88, 2.54)   1.65 (0.73, 3.73)  
  No Other Indication 2.41 (1.56, 3.73)   1.77 (0.94, 3.33)  
  1. a Democratic Republic of Congo, Niger, Nigeria
  2. b Cambodia, India, Nicaragua, Paraguay, Phillipines, Thailand, Vietnam, Algeria, Ecuador, Peru, Sri Lanka, Kenya, Nepal, Uganda, China
  3. c Argentina, Japan, Cuba, Brazil, Mexico
  4. d Medically High Risk Definition: is a dichotomous variable whereby women are considered to be medically high risk if they have chronic hypertension, cardiac or renal disease, pulmonary pathology, diabetes, malaria, sickle cell disease, severe anemia, urinary tract infection, severe condylomatous disease, or HIV or a condition associated with HIV
  5. e Obstetrically High Risk Definition: is a dichotomous variable whereby women are considered obstetrically high risk if they experience hypertension in pregnancy, pre-eclampsia, eclampsia, or have suspected fetal growth impairment
  6. p-values comparing women experiencing adverse outcomes to those who did not, adjusted for country of birth, are shown in the univariate analysis in Table 4
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