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Cited by 84Maternal and Perinatal Health InterventionsReproductive Health and ContraceptionMaternal and fetal healthcare

Medical and non-medical reasons for cesarean section delivery in Egypt: a hospital-based retrospective study

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Elnakib, Shatha, Abdel-Tawab, Nahla, Orbay, Doaa, Hassanein, Nevine·2019·BMC Pregnancy and Childbirth
DOI 10.1186/s12884-019-2558-2PMC PMC6842224
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Abstract

Background: Caesarean section (CS) is an important lifesaving intervention that can reduce maternal and newborn morbidity and mortality. The dramatic increase in CS rates globally has prompted concerns that the procedure may be overused or used for inappropriate indications. In Egypt, CS rates are alarmingly high, accounting for 52% of all deliveries. This study sought to (1) explore indications and risk factors for CS in public hospitals in four governorates in Egypt and (2) examine health care provider factors impacting the decision to perform a CS. Methods: We reviewed medical records for all deliveries that took place during April 2016 in 13 public hospitals situated in four governorates in Egypt (Cairo, Alexandria, Assiut and Behera), and extracted information pertaining to medical indications and women’s obstetric characteristics. We also interviewed obstetricians in the study hospitals to explore factors associated with the decision to perform CS. Results: A total of 4357 deliveries took place in the study hospitals during that period. The most common medical indications were previous CS (50%), an “other” category (13%), and fetal distress (9%). Multilevel analysis revealed that several obstetric risk factors were associated with increased odds of CS mode of delivery – including previous CS, older maternal age, and nulliparity – while factors such as partograph completion and oxytocin use were associated with reduced odds of CS. Interviews with obstetricians highlighted non-medical factors implicated in the high CS rates, including a convenience incentive, lack of supervision and training in public hospitals, as well as absence of or lack of familiarity with clinical guidelines. Conclusion: A combination of both medical and non-medical factors drives the increase in CS rates. Our analysis however suggests that a substantial number of CS deliveries took place in the absence of strong medical justification. Health care provider factors seem to be powerful factors influencing CS rates in the study hospitals.

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Authors
Elnakib, S., Abdel-Tawab, N., Orbay, D., & Hassanein, N.
Affiliations
Johns Hopkins University (US)
Corresponding author
Elnakib, Shatha
ORCID
Elnakib, Shatha
Venue
BMC Pregnancy and Childbirth
Publisher
Springer Science and Business Media LLC
Published
2019-11-08
Volume
19
Issue
1
Pages
411-411
ISSN
1471-2393 (ISSN-L)
DOI
10.1186/s12884-019-2558-2
PMC
PMC6842224
OpenAlex
W2985348304
Cited by
84
References
44
Citations by year
2026: 3 · 2025: 16 · 2024: 13 · 2023: 10 · 2022: 26 · 2021: 11 · 2020: 5
FWCI
11.42
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Pregnancy and Childbirth (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
United Nations Population Fund
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
Keywords
cesarean section, cesarean section rate, indications for cesarean section, prenatal risk factors, previous cesarean section, fetal distress, oxytocin use, clinical guideline adherence, Egypt
MeSH terms
Adult, Cesarean Section, Egypt, Female, Fetal Distress, Hospitals, Public, Humans, Infant, Infant Mortality, Infant, Newborn, Obstetric Labor Complications, Maternal Mortality, Pregnancy, Retrospective Studies, Risk Factors, Incidence, Young Adult

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