Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Reprod Health. 2020 Dec 17;17(1):197. doi: 10.1186/s12978-020-01039-x.
Global caesarean section (CS) rates have raised concern of a potential overuse of the procedure in both high- and low-resource settings. We sought to assess management and outcomes of deliveries with emergency CSs due to fetal distress and prolonged labor at 12 public hospitals in Nepal and determine factors associated with suboptimal CS indications.
We conducted a cross-sectional study on all deliveries between the 14th of April 2017 and the 17th of October 2018 at 12 public hospitals in Nepal and included all emergency CSs due to fetal distress and prolonged labor. Analysis was conducted using Pearson chi-square test and bivariate and multivariate logistic regression.
The total cohort included 104,322 deliveries of which 18,964 (18%) were CSs (13,095 [13%] emergency CSs and 5230 [5.0%] elective CSs). We identified 1806 emergency CSs due to fetal distress and 1322 emergency CSs due to prolonged labor. Among CSs due to fetal distress, only 36% had fetal heart rate monitoring performed according to protocol, and among CSs due to prolonged labor, the partograph was completely filled in only 8.6%. Gestational age < 37 weeks and birth weight < 2500 g were associated with more suboptimal CS indications due to fetal distress (adjusted odds ratio [aOR] 1.4, 95% confidence interval [CI] 1.1-1.8 and aOR 1.7, 95% CI 1.3-2.2 respectively) than those with gestational age > 37 weeks and birth weight > 2500 g. We found no association between suboptimal CS indications and maternal ethnicity or education level.
As fetal heart rate monitoring and partograph are fundamental to diagnose fetal distress and prolonged labor, the inappropriate monitoring proceeding CS decisions disclosed in our study indicate that CSs were performed on suboptimal indications. We call for improved quality of intrapartum monitoring, enhanced documentation in medical records, and structured auditing of CS indications in order to curb the potentially harmful CS trend.
全球剖宫产率的升高引起了人们对高、低收入国家过度使用剖宫产术的担忧。我们旨在评估尼泊尔 12 家公立医院因胎儿窘迫和产程延长而行急诊剖宫产的管理和结局，并确定与剖宫产术指征不理想相关的因素。
我们对 2017 年 4 月 14 日至 2018 年 10 月 17 日期间在尼泊尔 12 家公立医院分娩的所有产妇进行了一项横断面研究，纳入了所有因胎儿窘迫和产程延长而行的急诊剖宫产术。采用 Pearson 卡方检验和双变量及多变量逻辑回归进行分析。
总队列包括 104322 例分娩，其中 18964 例（18%）为剖宫产术（13095 例[13%]为急诊剖宫产术，5230 例[5.0%]为择期剖宫产术）。我们发现 1806 例因胎儿窘迫而行急诊剖宫产术，1322 例因产程延长而行急诊剖宫产术。在因胎儿窘迫而行的剖宫产术中，仅有 36%按照方案进行了胎心监护，而在因产程延长而行的剖宫产术中，仅有 8.6%完整填写了产程图。与孕龄>37 周且出生体重>2500 g 的产妇相比，因胎儿窘迫行剖宫产术的产妇中，孕龄<37 周且出生体重<2500 g 的产妇具有更多的不理想剖宫产术指征（校正优势比[aOR]为 1.4，95%置信区间[CI]为 1.1-1.8；aOR 为 1.7，95%CI 为 1.3-2.2）。我们没有发现不理想剖宫产术指征与产妇的民族或教育水平有关。
由于胎心监护和产程图是诊断胎儿窘迫和产程延长的基础，因此我们研究中发现的不适当监测程序与剖宫产术决策相关，表明剖宫产术是在不理想的指征下进行的。我们呼吁提高产时监测质量，加强病历记录，以及对剖宫产术指征进行结构化审核，以遏制潜在的有害剖宫产趋势。
