Dataset Information

Trends and determinants of increasing caesarean sections from 2010 to 2013 in a prospective population-based registry in eastern rural Maharashtra, India.

ABSTRACT:

Objective

Our objective was to describe trends in caesarean section (CS) rates, characteristics of women delivering by CS, reasons for CS and impact of CS on perinatal mortality, in a rural Indian population.

Design

Secondary data analysis using a prospective population-based registry.

Setting

Four districts in Eastern Maharashtra, India, 2010 to 2013.

Participants

39 026 pregnant women undergoing labour and delivery.

Main outcomes

CS, single most likely reason, perinatal mortality.

Results

Overall, 20% of the women delivered by CS. Rates increased from 17.4% in 2010 to 22.7% in 2013 (p<0.001) with an absolute risk increase from 1% to 5% during this time-period. Women aged 25+ years old, being nulliparous, having at least a secondary school education, a body mass index 25+ and a multiple gestation pregnancy were more likely to deliver by CS. Perinatal mortality was higher among babies delivered vaginally than those delivered by CS (4.5% vs 2.7%, p<0.001). Prolonged and obstructed labour as the reported reason for CS increased over time for both nulliparous and multiparous women (p<0.001), and 6% to 10% women had no clear reason for CS. Perinatal mortality was higher among babies born vaginally than those delivered by CS (adjusted OR: 0.65, 95% CI 0.56 to 0.76, p<0.001).

Conclusion

Rates of CS increased over time in rural Maharashtra, exceeding WHO recommendations. Characteristics associated with CS and outcomes of CS were similar to previous reports. Further studies are needed to ensure accuracy of reported reasons for CS, why obstructed and prolonged labour leading to CS is increasing in this population and what leads to CS without a clear indication. Such information may be helpful for implementing the Indian Government mandate that no CS be performed without strict medical indications, while ensuring that the overall CS rates are appropriate.

Trial registration number

NCT01073475.

SUBMITTER: Patel A

PROVIDER: S-EPMC6687025 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Trends and determinants of increasing caesarean sections from 2010 to 2013 in a prospective population-based registry in eastern rural Maharashtra, India.

Patel Archana A Pusdekar Yamini Vinod YV Prakash Amber Abhijeet AA Simmons Elizabeth E Waikar Manjushree M Rao Sowmya R SR Hibberd Patricia L PL

BMJ open 20190805 8

<h4>Objective</h4>Our objective was to describe trends in caesarean section (CS) rates, characteristics of women delivering by CS, reasons for CS and impact of CS on perinatal mortality, in a rural Indian population.<h4>Design</h4>Secondary data analysis using a prospective population-based registry.<h4>Setting</h4>Four districts in Eastern Maharashtra, India, 2010 to 2013.<h4>Participants</h4>39 026 pregnant women undergoing labour and delivery.<h4>Main outcomes</h4>CS, single most likely reaso ...[more]

PMID: 31383691

Similar Datasets

Project description:BackgroundAnemia during pregnancy may be associated with poor infant outcomes, although its consequences may vary based on etiology and timing.ObjectivesWe examined the associations between anemia and anemia-related biomarkers during pregnancy and infant outcomes [birthweight, gestational age at birth, birthweight-for-gestational age percentile, and infant hemoglobin (Hb) at 6 wk of age] in Nagpur, Eastern Maharashtra, India.MethodsWe conducted a prospective cohort study of 200 pregnant women. In the first trimester, venous blood was collected to assess Hb via cyanmethemoglobin analysis, micronutrient status (ferritin, vitamin B12, and folate), and inflammation (C-reactive protein). Hb was also assessed in capillary samples using a hemoglobinometer in the first and third trimesters for mothers and at 6 wk for infants. Associations were assessed using generalized linear models controlling for background characteristics.ResultsIn the first trimester, high (compared with normal) venous Hb was significantly associated with lower gestational age at birth [β: -1.0 wk, 95% confidence interval (CI): -1.9, -0.2] and higher birthweight-for-gestational age percentile (β: 20.1, 95% CI: 9.0, 31.2). Mild anemia, moderate anemia, and high (compared with normal) capillary Hb were significantly associated with lower birthweight (β: -147.7 g, 95% CI: -243.4, -51.7; β: -77.7 g, 95% CI: -123.9, -31.4; and β: -236.0 g, 95% CI: -478.0, -48.1) and birthweight-for-gestational age percentile (β: -7.3, 95% CI: -13.7, -0.9; β: -8.4, 95% CI: -14.1, -2.8; and β: -8.9, 95% CI: -15.9, -1.9). Higher serum ferritin was significantly associated with higher birthweight (β: 2.0 g, 95% CI: 0.1, 3.9) and gestational age at birth (β: 0.01 wk, 95% CI: 0.00, 0.01). In the third trimester, mild anemia was significantly associated with lower gestational age at birth (β: -0.5 wk, 95% CI: -0.7, -0.3).ConclusionsAssociations between maternal anemia during pregnancy and infant outcomes were mixed indicating further studies are needed to better understand these relationships.

Project description:BackgroundPrevious literature suggests that men reporting more gender-equitable attitudes are more likely to use condoms, but there is a paucity of data evaluating whether these attitudes are associated with contraceptive communication and use. The objective of this study is to test the hypothesis that men reporting more gender-equitable attitudes will be more likely to (a) engage in contraceptive communication with their wives and (b) that they and/or their wives will be more likely to use all forms of family planning, compared to men with less equitable attitudes.MethodsUsing cross-sectional dyadic survey data from young married couples from rural Maharashtra, India (N = 989), we assessed the associations between men's gender role attitudes and a) spousal contraceptive communication and b) contraceptive use by type (none, traditional, condoms, pills, or IUD). The contraceptive use outcome is based on wives' report. We assessed these associations via bivariate t-test (communication outcome) or ANOVA test (contraceptive type outcome), as well as unadjusted and adjusted logistic (communication outcome) and multinomial logistic (contraceptive type outcome) regression models. Adjusted models included sociodemographic factors selected a priori based on established associations with gender-equitable attitudes and/or our assessed outcomes.FindingsMen with more gender-equitable attitudes were more likely to discuss family planning with their wives (AOR = 1·05, 95%CI 1·03-1·07, p < 0·001) and to use condoms (ARRR = 1·03, 95%CI 1·00-1·06, p = 0·07). There was no association between gender-equitable attitudes and use of other types of contraception.InterpretationWhile gender-equitable attitudes among men may facilitate condom use and family planning communication in marriage, they do not appear to be linked with greater likelihood of use of more effective types of contraceptive use. This suggests that males supportive of gender equity may take greater responsibility for family planning vis a vis a less effective contraceptive, condoms, in the absence of more effective short-acting contraceptives for men.FundingThe National Institutes of Health [Grant number 5R01HD084453-01A1] and the Bill & Melinda Gates Foundation, Seattle, WA [grant number INV-002967].

Dataset Information

Trends and determinants of increasing caesarean sections from 2010 to 2013 in a prospective population-based registry in eastern rural Maharashtra, India.

Objective

Design

Setting

Participants

Main outcomes

Results

Conclusion

Trial registration number

Publications

Trends and determinants of increasing caesarean sections from 2010 to 2013 in a prospective population-based registry in eastern rural Maharashtra, India.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets