Elective versus non-elective caesarean sections: A multinomial regression analysis of predictors and foetal outcome in a Tertiary Health Facility in Southwestern Nigeria
Authors: AKADRI Adebayo
Journal: Babcock University Medical Journal
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Abstract
Objective: This study assessed the demographic and obstetric predictors of elective and non-elective caesarean section and the fetal outcomes at Babcock University Teaching Hospital (BUTH). Methods: A cross-sectional study of 447 pregnant women who delivered between August 2020 and February 2022 at BUTH. Statistical analysis was done using IBM-SPSS version 23.0. Multinomial logistic regression analysis was used to identify specific predictors of both elective and non-elective caesarean sections. Results: We found that being aged 30 years and older (AOR 2.5 CI 1.3-5.0; p: 0.007), having low birth order [(order 1, AOR 3.4 CI 1.4-8.3; p: 0.008), (order 2, AOR 2.5 CI 1.1-5.8; p: 0.027)], history of CS (AOR 200.8 CI 56.3-716.9; p: <0.001) and non-cephalic foetal presentation (AOR 61.9 CI 7.2-529.7; p: <0.001) predicted elective CS delivery while low birth order (order 1, AOR 3.6 CI 1.8-7.1; p: <0.001), gestational age between 37 and 40 weeks (AOR 3.7 CI 1.6-8.4; p: 0.002) and history of CS (AOR 22.3 CI 6.0-82.1; p: <0.001) predicted non-elective CS. Foetal morbidities such as birth asphyxia, prematurity and low birth weight were significantly higher in women who had non-elective CS. Conclusion: This study has demonstrated that advanced maternal age, low birth order, history of CS and non cephalic presentation predicted elective CS, while low birth order, history of CS and gestational age 37-40 weeks predicted non-elective CS. Advocacy for early commencement of family planning and having well-justified indications for the first CS may be useful strategies for optimizing caesarean delivery at the facility level in Nigeria.
