Differences in rates and odds for emergency caesarean section in six Palestinian hospitals: a population-based birth cohort study

Mohammed Zimmo, Katariina Laine, Sahar Hassan, Erik Fosse, Marit Lieng, Hadil Ali-Masri, Kaled Zimmo, Marit Anti, Bettina Bottcher, Ragnhild Sørum Falk, Åse Vikanes, Mohammed Zimmo, Katariina Laine, Sahar Hassan, Erik Fosse, Marit Lieng, Hadil Ali-Masri, Kaled Zimmo, Marit Anti, Bettina Bottcher, Ragnhild Sørum Falk, Åse Vikanes

Abstract

Objective: To assess the differences in rates and odds for emergency caesarean section among singleton pregnancies in six governmental Palestinian hospitals.

Design: A prospective population-based birth cohort study.

Setting: Obstetric departments in six governmental Palestinian hospitals.

Participants: 32 321 women scheduled to deliver vaginally from 1 March 2015 until 29 February 2016.

Methods: To assess differences in sociodemographic and antenatal obstetric characteristics by hospital, χ2 test, analysis of variance and Kruskal-Wallis test were applied. Logistic regression was used to estimate differences in odds for emergency caesarean section, and ORs with 95% CIs were assessed.

Main outcome measures: The primary outcome was the adjusted ORs of emergency caesarean section among singleton pregnancies for five Palestinian hospitals as compared with the reference (Hospital 1).

Results: The prevalence of emergency caesarean section varied across hospitals, ranging from 5.8% to 22.6% among primiparous women and between 4.8% and 13.1% among parous women. Compared with the reference hospital, the ORs for emergency caesarean section were increased in all other hospitals, crude ORs ranging from 1.95 (95% CI 1.42 to 2.67) to 4.75 (95% CI 3.49 to 6.46) among primiparous women. For parous women, these differences were less pronounced, crude ORs ranging from 1.37 (95% CI 1.13 to 1.67) to 2.99 (95% CI 2.44 to 3.65). After adjustment for potential confounders, the ORs were reduced but still statistically significant, except for one hospital among parous women.

Conclusion: Substantial differences in odds for emergency caesarean section between the six Palestinian governmental hospitals were observed. These could not be explained by the studied sociodemographic or antenatal obstetric characteristics.

Keywords: maternal medicine; obstetrics; prenatal diagnosis.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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