Increased cesarean section rate in Central Saudi Arabia: a change in practice or different maternal characteristics

Figures & data

Table 1 Data characteristics of the two studied groups (G1 vs G2)

Participants characteristics	Variables indicator	G1 no (%)	G2 no (%)	OR (95% CI)	P-value
Age	Mean (SD)	30.1 (6.4)	29.9 (6.4)	n/a	0.75
BMI	Mean (SD)	33.3 (6.9)	32.8 (6.4)	n/a	0.43
Parity	Mean (SD)	3.1 (3.3)	2.4 (2.7)	n/a	0.02*
Gestational age	Mean (SD)	38.5 (2.0)	38.4 (2.1)	n/a	0.72
Antenatal care	Yes	192 (97.0%)	181 (90.5%)	0.30 (0.12–0.76)	0.008*
Type of CS	Elective primary CS	60 (30.3%)	58 (29.0%)	n/a	0.85
	Elective secondary CS	41 (20.7%)	44 (22.0%)	n/a	n/a
	Emergency primary CS	80 (40%)	83 (41.5%)	n/a	n/a
	Emergency secondary CS	17 (8.6%)	15 (7.5%)	n/a	n/a
Primary vs secondary CS	Primary	140 (70.7%)	141 (70.5%)	1.01 (0.66–0.56)	0.96
	Secondary	58 (29.3%)	59 (29.5%)	n/a	n/a
Elective vs emergency CS	Elective	101 (51.0%)	102 (51.0%)	1.00 (0.68–1.48)	1.00
	Emergency	97 (49.0%)	98 (49.0)	n/a	n/a
Medical history	Yes	2 (1.0%)	6 (3.0%)	3.03 (0.60–15.20)	0.16
Surgical history	Yes	1 (0.5%)	10 (5.0%)	10.37 (1.32–81.78)	0.006*
Blood loss	≤500 mL	152 (76.8%)	137 (68.5%)	n/a	0.16
	>500, <1,000 mL	44 (22.2%)	57 (28.5%)	n/a	n/a
	≥1,000, <1,500 mL	1 (0.5%)	5 (2.5%)	n/a	n/a
	>1,500 mL	1 (0.5%)	1 (0.5%)	n/a	n/a
PPH	Yes	2 (1.0%)	6 (3.0%)	3.03 (0.60–15.20)	0.16
Abnormal CTG	Yes	35 (17.7%)	42 (21.0%)	1.24 (0.75–2.04)	0.40

Note: The symbol *indicates statistically significant value.

Abbreviations: G1, women who delivered by CS during the year 2002; G2, women who delivered by CS during 2009; CS, cesarean section; OR, odds ratio; CI, confidence interval; SD, standard deviation; n/a, not applicable; BMI, body mass index; PPH, postpartum hemorrhage; CTG, cardiotocography.

Table 2 Different CS delivery indications for the two studied groups (G1 vs G2)

Cesarean section indications	Variables indicator	G1 no (%)	G2 no (%)	OR (95% CI)	P-value
Failure to progress	Yes	54 (27.3%)	38 (19.0%)	0.63 (0.39–1.00)	0.05*
Abnormal CTG	Yes	35 (17.7%)	42 (21.0%)	1.24 (0.75–2.04)	0.40
APH	Yes	10 (5.1%)	9 (4.5%)	0.89 (0.35–2.23)	0.80
Cord prolapse	Yes	3 (1.5%)	0 (0.0%)	n/a	0.08
Uterine rupture	Yes	1 (0.5%)	0 (0.0%)	n/a	0.31
Abnormal lie/presentation	Yes	15 (7.6%)	5 (2.5%)	0.31 (0.11–0.88)	0.02*
Multiple pregnancy	Yes	14 (7.1%)	14 (7.0%)	0.99 (0.46–2.13)	0.98
Repeated CS	Yes	56 (28.3%)	60 (30.0%)	1.09 (0.71–1.68)	0.71
IUGR	Yes	1 (0.5%)	8 (4.0%)	8.21 (1.02–66.25)	0.02*
CDMR	Yes	1 (0.5%)	5 (2.5%)	0.20 (0.02–1.71)	0.02*
Others	Yes	25 (12.6%)	10 (5.0%)	0.36 (0.17–0.78)	0.007

Note: The symbol *indicates statistical significant value.

Abbreviations: CS, cesarean section; G1, women who delivered by CS during the year 2002; G2, women who delivered by CS during 2009; OR, odds ratio; CI, confidence interval; n/a, not applicable; CTG, cardiotocography; APH, antepartum hemorrhage; IUGR, intrauterine growth restriction; CDMR, cesarean delivery on maternal request.

Table 3 Surgical data and the various maternal and neonatal outcomes for the two studied groups (G1 vs G2)

General measures	Variables indicator	G1 no (%)	G2 no (%)	OR (95% CI)	P-value
Seniority of decision taker	Consultant	156 (78.8%)	134 (67.0%)	Reference	Reference
	Resident	26 (13.1%)	30 (15.0%)	1.34 (0.76–2.38)	0.31
	Intermediate level	16 (8.1%)	36 (18.0%)	2.62 (1.39–4.93)	0.002
Performing surgeon	Consultant	22 (11.1%)	17 (8.5%)	Reference	Reference
	Resident	31 (15.7%)	36 (18.0%)	1.50 (0.68–3.33)	0.31
	Intermediate level	145 (73.2%)	147 (73.5%)	1.31 (0.67–2.57)	0.43
Surgical assistant	Consultant	14 (7.1%)	8 (4.0%)	Reference	Reference
	Resident	153 (77.3%)	152 (76.0%)	1.74 (0.71–4.26)	0.22
	Intermediate level	31 (15.7%)	40 (20.0%)	2.26 (0.84–6.10)	0.1
Type of anesthesia	General	141 (71.6%)	33 (16.5%)	Reference	Reference
	Spinal	48 (24.4%)	148 (74.0%)	13.17 (7.99–21.71)	<0.0001*
	Epidural	8 (4.1%)	19 (9.5%)	10.15 (4.09–25.18)	<0.0001*
Length of hospital stay (days)	Mean (SD)	4.3 (0.8)	3.4 (0.8)	n/a	0.001*
Maternal IOC
IOC	Yes	5 (2.5%)	4 (2.0%)	0.79 (0.21–2.98)	0.73
Maternal STPOC
STPOC	Yes	3 (1.5%)	1 (0.5%)	0.33 (0.03–3.17)	0.31
Maternal LTPOC
LTPOC	Yes	2 (1.0%)	1 (0.5%)	0.49 (0.04–5.48)	0.56
Neonatal outcome/complication
Sex	Male	98 (49.5%)	104 (52.0%)	0.91 (0.61–1.34)	0.62
	Female	100 (50.5%)	96 (48.0%)	n/a	n/a
Weight (g)	Mean (SD)	3170.9 (581.0)	3084.2 (595.0)	n/a	0.14
Cord pH	Mean (SD)	7.3 (0.1)	7.2 (0.1)	n/a	0.09
Apgar score at first minute	Mean (SD)	7.9 (1.5)	7.9 (1.6)	n/a	0.54
Apgar score at fifth minute	Mean (SD)	8.9 (0.7)	8.8 (0.9)	n/a	0.12
Place of admission	Regular nursery	171 (86.4%)	176 (88.0%)	Reference	Reference
	ICN	21 (10.6%)	7 (3.5%)	0.32 (0.13–0.78)	0.009*
	NICU	6 (3.0%)	17 (8.5%)	2.75 (1.06–7.15)	0.03*

Note: The symbol *indicates statistically significant value.

Abbreviations: G1, women who delivered by CS during the year 2002; G2, women who delivered by CS during 2009; OR, odds ratio; CI, confidence interval; SD, standard deviation; n/a, not applicable; IOC, intraoperative complication; STPOC, short-term postoperative complication; LTPOC, long-term postoperative complication; ICN, intermediate care unit; NICU, neonatal intensive care unit; CS, cesarean section.