Cesarean section delivery rates, determinants, and indications: a retrospective study in Dekemhare Hospital

Objectives: Cesarean section delivery is at increasing rate worldwide. The present study was designed to explore the cesarean section delivery rate, and its common indications along with their socio-demographic determinants in Dekemhare Hospital, Southern region of Eritrea. Methods and Materials: A retrospective study was utilized to retrieve data of all women who delivered in Dekemhare Hospital during 2019. Using a structured questionnaire, all information required was recorded using data files such as birth (vaginal and cesarean) files, pregnancy registration file, and neonatal data. All women who delivered by cesarean section, their indications were collected reviewing registration records of the operating theater where the procedure was conducted. To describe the results, both descriptive and analytical analysis were conducted using SPSS version 25. χ2 test and multivariate logistic regression analysis were done to identify determinants of cesarean section. A significance level of 0.05 was used as a cut point of statistical significance. Main Findings: The rate of cesarean section delivery was 10.1%. The top 6 indications of cesarean section were: malposition (26.3%), prolonged and obstructed labor (21.2%), mal-presentation (14.4%), previous/repeat cesarean section (10.2%), amniotic fluid disorders (9.3%), and fetal distress (5.9%). Mothers who were nulliparous [odds ratio (OR): 9.2; 95% confidence interval (CI): 1.8–14.3; P-value: 0.007], referral from other health facility (OR: 7.8, 95% CI: 3.7–16.5, P-value <0.0001), and who had delivered stillbirths (OR: 8.2; 95% CI: 1.7–38.9; P-value: 0.008) were more likely to deliver through cesarean section. Conclusion: The rate of cesarean section in Dekemhare hospital is fairly optimal (10.1%). Prolonged and obstructed labor, mal-presentation and malposition were the most common indications. Nulliparous and referral mothers had higher risk of cesarean section. Decision-making for cesarean section should outweigh the benefits and risks of the intervention within the context of women’s entire reproductive life-cycle.