A Prospective, Population-Based Study of Trends in Operative Vaginal Delivery Compared to Cesarean Delivery Rates in Low- and Middle-Income Countries, 2010–2016

Margo S. Harrison; Sarah Saleem; Sumera Ali; Omrana Pasha; Elwyn Chomba; Waldemar A. Carlo; Ana L. Garces; Nancy F. Krebs; K. Michael Hambidge; Shivaprasad S. Goudar; S. M. Dhaded; Bhala Kodkany; Richard J. Derman; Archana Patel; Patricia L. Hibberd; Fabian Esamai; Edward A. Liechty; Antoinette Tshefu; Adrien Lokangaka; Melissa Bauserman; Carl L. Bose; Fernando Althabe; Jose M. Belizan; Pierre Buekens; Janet L. Moore; Dennis D. Wallace; Menachem Miodovnik; Marion Koso-Thomas; Elizabeth M. McClure; Robert L. Goldenberg

doi:10.1055/s-0038-1673656

American Journal of Perinatology, Table of Contents

Am J Perinatol 2019; 36(07): 730-736
DOI: 10.1055/s-0038-1673656

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Prospective, Population-Based Study of Trends in Operative Vaginal Delivery Compared to Cesarean Delivery Rates in Low- and Middle-Income Countries, 2010–2016

Margo S. Harrison

¹University of Colorado School of Medicine, Denver, Colorado

,

Sarah Saleem

²Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan

,

Sumera Ali

²Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan

,

Omrana Pasha

²Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan

,

Elwyn Chomba

³University Teaching Hospital, University of Zambia, Lusaka, Zambia

,

Waldemar A. Carlo

⁴University of Alabama at Birmingham, Birmingham, Alabama

,

Ana L. Garces

⁵Unidad de Planificación Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala City, Guatemala

,

Nancy F. Krebs

¹University of Colorado School of Medicine, Denver, Colorado

,

K. Michael Hambidge

¹University of Colorado School of Medicine, Denver, Colorado

,

Shivaprasad S. Goudar

⁶KLE University's Jawaharlal Nehru Medical College, Belgaum, India

,

S. M. Dhaded

⁶KLE University's Jawaharlal Nehru Medical College, Belgaum, India

,

Bhala Kodkany

⁶KLE University's Jawaharlal Nehru Medical College, Belgaum, India

,

Richard J. Derman

⁷Thomas Jefferson University, Philadelphia, Pennsylvania

,

Archana Patel

⁸Lata Medical Research Foundation, Nagpur, Maharashtra, India

,

Patricia L. Hibberd

⁹Boston University, Boston, Massachusetts

,

Fabian Esamai

¹⁰Moi University School of Medicine, Eldoret, Kenya

,

Edward A. Liechty

¹¹Indiana University School of Medicine, Indianapolis, Indiana

,

Antoinette Tshefu

¹²Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo

,

Adrien Lokangaka

¹²Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo

,

Melissa Bauserman

¹³Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina

,

Carl L. Bose

¹³Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina

,

Fernando Althabe

¹⁴Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina

,

Jose M. Belizan

¹⁴Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina

,

Pierre Buekens

¹⁵Tulane School of Public Health and Tropic Medicine, New Orleans, Louisiana

,

Janet L. Moore

¹⁶RTI International, Durham, North Carolina

,

Dennis D. Wallace

¹⁶RTI International, Durham, North Carolina

,

Menachem Miodovnik

¹⁷ Eunice Kennedy Shriver , National Institute of Child Health and Human Development, Rockville, Maryland

,

Marion Koso-Thomas

¹⁷ Eunice Kennedy Shriver , National Institute of Child Health and Human Development, Rockville, Maryland

,

Elizabeth M. McClure

¹⁶RTI International, Durham, North Carolina

,

Robert L. Goldenberg

¹⁸Department of Obstetrics/Gynecology, Columbia University, New York, New York

› Author Affiliations

Abstract

Objective Few data are available on cesarean delivery and operative vaginal delivery trends in low- and middle-income countries. Our objective was to analyze a prospective population-based registry including eight sites in seven low- and middle-income countries to observe trends in operative vaginal delivery versus cesarean delivery rates over time, across sites.

Study Design A prospective population-based study, including home and facility births among women enrolled from 2010 to 2016, was performed in communities in Argentina, Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, and Zambia. Women were enrolled during pregnancy and delivery outcome data were collected.

Results We analyzed 354,287 women; 4,119 (1.2%) underwent an operative vaginal delivery and 45,032 (11.2%) delivered by cesarean. Across all sites with data for 7 years, rates of operative vaginal delivery decreased from 1.6 to 0.3%, while cesarean delivery increased from 6.4 to 14.4%. Similar trends were seen when individual country data were analyzed. Operative vaginal delivery rates decreased in both hospitals and clinics, except in the hospital setting at one of the Indian sites.

Conclusion In low- and middle-income countries, operative vaginal delivery is becoming less utilized while cesarean delivery is becoming an increasingly common mode of delivery.

Keywords

operative vaginal delivery - cesarean delivery - mode of delivery - low- and middle-income countries - facility-based delivery

Full Text

References

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