Department of Obstetrics and Gynecology, University of Ghana Medical School, P. O. Box GP4236, Accra, Ghana.
Faculty of Epidemiology and Population Health, London School of Tropical Medicine and Hygiene, London, United Kingdom.
Matern Child Health J. 2022 Jan;26(1):177-184. doi: 10.1007/s10995-021-03290-5. Epub 2021 Dec 2.
Significant inequalities still exist between low- and high-income countries regarding access to optimum emergency obstetric care including life-saving emergency caesarean section. These relationships are considerably stronger between population-based caesarean section rates and socio-economic characteristics with poorest households experiencing significant unmet needs persistently.
To explore the characteristics of women receiving emergency C-section using a new, validated definition in Ghana and the Dominican Republic.
This was a cross-sectional study conducted in Ghana and the Dominican Republic. Multivariable logistic regression analysis was used to determine women's characteristics associated with emergency C-section.
This analysis included 2166 women who had recently delivered via C-section comprising 653 and 1513 participants from Accra and Santo Domingo, DR, respectively. Multivariable analyses showed that women, both in Ghana and the DR, were more likely to have an emergency C-section if they did not have a previous C-Section (adjusted Odds Ratio (aOR): 2.45, 95% CI [1.57-3.81]; and aOR: 15.5, 95% CI [10.5-22.90], respectively) and if they were having their first childbirth, compared to women with previous childbirth (aOR: 1.77, 95%CI [1.13-2.79]; and aOR: 1.46, 95%CI [1.04-2.04], respectively). Also, preterm birth was associated with significantly decreased likelihood of emergency C-section compared with childbirth occurring at term in both Ghana and the DR (aOR: 0.31, 95%CI [0.20-0.48]; and aOR: 0.43, 95%CI [0.32-0.58], respectively). Among the Ghanaian participants, having an emergency C-section was positively associated with being referred and negatively associated with being older than 35 years of age. Characteristics such as education, religion, marital status, and residence did not differ between women's emergency versus non-emergency C-section status.
Emergency C-section was found to be significantly higher in women with no prior C-section or those having their first births but lower in those with preterm birth in both Ghana and the DR. Data from additional countries are needed to confirm the relationship between emergency C-section status and socio-economic and obstetric characteristics, given that the types of interventions required to assure equitable access to potentially life-saving C-section will be determined by how and when access to care is being denied or not available.
在获得最佳紧急产科护理方面，包括救命的紧急剖宫产，低收入和高收入国家之间仍然存在显著不平等。这些关系在基于人群的剖宫产率与社会经济特征之间更为明显，最贫困家庭的需求持续得不到满足。
探讨在加纳和多米尼加共和国使用新的经过验证的定义接受紧急剖宫产的妇女的特征。
这是一项在加纳和多米尼加共和国进行的横断面研究。多变量逻辑回归分析用于确定与紧急剖宫产相关的妇女特征。
这项分析包括 2166 名最近通过剖宫产分娩的妇女，其中分别有 653 名和 1513 名来自阿克拉和多米尼加共和国圣多明各的参与者。多变量分析显示，如果加纳和多米尼加共和国的妇女没有剖宫产史（调整后的优势比 (aOR)：2.45，95%置信区间 [1.57-3.81]；和 aOR：15.5，95%CI [10.5-22.90]）并且是第一次分娩，与有既往分娩史的妇女相比，她们更有可能进行紧急剖宫产（aOR：1.77，95%CI [1.13-2.79]；和 aOR：1.46，95%CI [1.04-2.04]）。此外，与足月分娩相比，早产与紧急剖宫产的可能性显著降低（aOR：0.31，95%CI [0.20-0.48]；和 aOR：0.43，95%CI [0.32-0.58]）。在加纳参与者中，紧急剖宫产与转诊呈正相关，与年龄大于 35 岁呈负相关。教育、宗教、婚姻状况和居住地等特征在紧急剖宫产和非紧急剖宫产妇女之间没有差异。
在加纳和多米尼加共和国，无剖宫产史或首次分娩的妇女紧急剖宫产率显著较高，但早产妇女紧急剖宫产率较低。鉴于确定确保公平获得潜在救命剖宫产的干预措施的类型将取决于如何以及何时获得或无法获得护理，因此需要来自其他国家的数据来确认紧急剖宫产状况与社会经济和产科特征之间的关系。
