Pregnancy outcomes associated with Cesarean deliveries in Peruvian public health facilities

Figures & data

Table 1 Rates of vaginal deliveries, cesarean deliveries, and elective cesarean deliveries in each Peruvian geographical region (coast, highlands, jungle) in 43 health care centers according to scarred uterus, prior pregnancies, preeclampsia, and level of the hospital in which deliveries were attended

Population (563,668)	Vaginal deliveries (411,558)		Cesarean deliveries (all types) (152,110)		Elective cesarean deliveries (82,621)
Characteristic	N	%	n	%	n	%
Geographical region
Coast (245,385)	164,841	67.2	80,544	32.8	41,937	52.1
Highlands (192,530)	146,930	76.3	45,600a	23.7	25,563a	56.1
Jungle (125,753)	99,787	79.4	25,966a,b	20.6	15,121a,b	58.2
Scarred uterus
Coast (29,859)	7,605	25.5	22,254	74.5	12,999	58.4
Highlands (12,394)	4,115	33.2	8,279a	66.8	5,270	63.7
Jungle (9,208)	3,185	34.6	6,023a,c	65.4	3,938	65.4
Multiparous
Coast (144,893)	96,489	66.6	48,404	33.4	26,845	55.5
Highlands (114,115)	85,222	76.7	25,893a	23.2	15,295	59.1
Jungle (83,839)	67,034	80.0	16,805a,c	20.0	10,153	60.4
Preeclampsia
Coast (13,369)	4,517	33.8	8,852	66.2	5,153	58.2
Highlands (5,590)	2,113	37.8	3,477a	62.2	2,308	66.4
Jungle (4,431)	2,246	50.7	2,185a,b	49.3	1,431	65.5
Level II hospital
Coast (8,896)	6,310	70.9	2,586	29.1	1,827d	70.7
Highlands (23,093)	18,715	81.0	4,378a	19.0	2,801d	64.0
Jungle (21,229)	18,164	85.6	3,065a,c	14.4	2,131d	69.5
Level III hospital
Coast (236,254)	158,359	67.0	77,895	33.0	40,059	51.4
Highlands (167,481)	126,955	75.8	40,526a	24.2	22,369	55.2
Jungle (104,124)	81,395	78.2	22,729a,c	21.8	12,862	56.6

Notes: The sum of the first and second columns represents the total number of deliveries (vaginal and cesarean sections).

a P < 0.01 with respect to deliveries at the coast;

b P < 0.01 with respect to deliveries in the highlands;

c P < 0.05 with respect to deliveries in the highlands;

d P < 0.01 with respect to elective cesarean section deliveries observed in level III hospitals.

Figure 1 Trends for cesarean section rates in Peru according to geographical region, 2000–2010.

Note: *chi-square test: P < 0.05 compared to year 2000.

Figure 2 Main indications for cesarean section rates in 43 Peruvian health facilities, 2000–2010.

Abbreviations: AFD, acute fetal distress; CPD, cephalopelvic disproportion; PP, placenta previa.

Table 2 Rates of adverse pregnancy outcomes according to the mode of delivery (vaginal or cesarean section) in 43 health facilities in Peru, 2000–2010

Pregnancy outcome*	Vaginal delivery (411,558)		Cesarean section delivery (152,110)
	n	%	n	%
Stillbirth	6,037	1.47	2,135	1.40
Preterm delivery	21,293	5.17	15,430	10.1
Twin pregnancy	3,541	0.86	5,930	3.9
Maternal mortality	76	0.02	165	0.11
Preeclampsia	8,876	2.16	14,514	9.54

Note:

* chi-square test: P < 0.01 between data after vaginal and cesarean section deliveries.

Table 3 Rates of adverse pregnancy outcomes in 43 health facilities in Peru by type of delivery within each cesarean section rate (CSR) level, 2000–2010

Health facility deliveries by CSR level (n)	Stillbirths (8,172)		Preterms (36,723)		Preeclampsia (23,390)		Maternal mortality (241)
	n	%	n	%	n	%	n	%
CSR < 10% (2)	1	1.72	3	5.17	–		–
C-section (58)
Vaginal (918)	4	0.44	27	2.94	–		–
CSR 10%–20% (12)	341	1.97a	1,937	11.19a	1,579	9.13a	16	0.09
C-section (17,299)
Vaginal (90,260)	1,086	1.20b	4,770	5.28b	1,774	1.97b	14	0.02b
CSR 20%–30% (18)	948	1.52a	6,846	11.00a	5,381	8.64a	75	0.12
C-section (62,231)
Vaginal (188,019)	2,831	1.51	9,646	5.13b	3,501	1.86b	37	0.02b
CSR > 30% (11)	845	1.17	6,644	9.16	7,554	10.42	74	0.10
C-section (72,522)
Vaginal (132,361)	2,116	1.60b	6,850	5.17b	3,601	2.72b	25	0.02b

Notes: In each facility group, vaginal deliveries and their association with stillbirths, preterm births, preeclampsia, and maternal mortality were also assessed.

a P < 0.0001 with respect to the value observed in the CSR > 30% group;

b P < 0.0001 with respect to the adverse outcome observed after cesarean section.

Figure 3 Trends for elective and emergency cesarean deliveries in 43 Peruvian health care centers, 2000–2010.

Note: *chi-square test: P < 0.05 compared to year 2000.

Table 4 ORs for maternal mortality associated with cesarean deliveries in 43 Peruvian health care centers, 2000–2010

Characteristic	Maternal mortality
	ORc	P	ORa	P	95% CI
Mode of delivery
Vaginal	1.0	–	1.0	–	–
Elective cesarean	6.10	0.001	4.45	0.001	3.21 6.18
Emergency cesarean	5.61	0.001	4.82	0.001	3.44 6.75
Geographical region
Coast	1.0	–	1.0	–	–
Highlands	1.34	0.04	1.83	0.001	1.35 2.48
Jungle	1.10	0.57	1.69	0.003	1.19 2.40
Previous cesarean
No	1.0	–	1.0	–	–
Yes	1.05	0.823	0.56	0.012	0.36 0.88
Hospital level
I	7.71	0.027	5.55	0.012	1.46 21.0
II	1.0	–	1.0	–	–
III	3.01	0.004	2.37	0.017	1.16 4.08

Notes: Logistic regression model adjusted by age, body mass index, anemia, preeclampsia, prenatal care, twin pregnancy, urinary tract infections, and previous cesarean delivery.

Abbreviations: CI, confidence interval; OR, odds ratio; ORa, adjusted OR; ORc, crude OR.