A Prospective, Population-Based Study of Trends in Operative Vaginal Delivery Compared to Cesarean Delivery Rates in Low- and Middle-Income Countries, 2010–2016Funding This study was funded by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development: U01 HD040477, U01 HD043475, U01 HD043464, U01 HD040657, U01 HD042372, U01 HD040607, U01HD040636, U01 HD040574, U01 HD40636.
14 March 2018
01 September 2018
29 October 2018 (online)
Objective Few data are available on cesarean delivery and operative vaginal delivery trends in low- and middle-income countries. Our objective was to analyze a prospective population-based registry including eight sites in seven low- and middle-income countries to observe trends in operative vaginal delivery versus cesarean delivery rates over time, across sites.
Study Design A prospective population-based study, including home and facility births among women enrolled from 2010 to 2016, was performed in communities in Argentina, Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, and Zambia. Women were enrolled during pregnancy and delivery outcome data were collected.
Results We analyzed 354,287 women; 4,119 (1.2%) underwent an operative vaginal delivery and 45,032 (11.2%) delivered by cesarean. Across all sites with data for 7 years, rates of operative vaginal delivery decreased from 1.6 to 0.3%, while cesarean delivery increased from 6.4 to 14.4%. Similar trends were seen when individual country data were analyzed. Operative vaginal delivery rates decreased in both hospitals and clinics, except in the hospital setting at one of the Indian sites.
Conclusion In low- and middle-income countries, operative vaginal delivery is becoming less utilized while cesarean delivery is becoming an increasingly common mode of delivery.
Keywordsoperative vaginal delivery - cesarean delivery - mode of delivery - low- and middle-income countries - facility-based delivery
OVD (forceps- and vacuum-assisted vaginal delivery) is decreasing in the LMICs, while cesarean delivery rates are increasing.
M.S.H. and R.L.G. conceived the analyses plan and drafted the first manuscript draft. W.A.C., C.L.B., E.M.M., D.D.W., N.F.K., K.M.H., A.L.G., P.B., and F.E. edited the manuscript. S.S., O.P., E.C., W.A.C., A.L.G., N.F.K., K.M.H., S.S.G., B.K., R.J.D., A.P., P.L.H., F.E., E.A.L., A.T., A.L., C.L.B., F.A., J.M.B., P.B., M.M., M.K.T., E.M.M., and R.L.G. developed the protocol. S.S., S.A., E.C., A.L.G., S.S.G., S.M.D., A.P., F.E., A.L., A.T., and F.A. oversaw the study implementation. J.L.M., E.M.M., and D.D.W. conducted the study analyses. All authors reviewed and approved the final manuscript.
- 1 Muraca GM, Sabr Y, Brant R, Cundiff GW, Joseph KS. Temporal and regional variations in operative vaginal delivery in Canada by pelvic station, 2004–2013. J Obstet Gynaecol Can 2016; 38 (07) 627-635
- 2 McQuivey RW. Vacuum-assisted delivery: a review. J Matern Fetal Neonatal Med 2004; 16 (03) 171-180
- 3 Notzon FC. International differences in the use of obstetric interventions. JAMA 1990; 263 (24) 3286-3291
- 4 Bailey PE, van Roosmalen J, Mola G, Evans C, de Bernis L, Dao B. Assisted vaginal delivery in low and middle income countries: an overview. BJOG 2017; 124 (09) 1335-1344
- 5 Operative Vaginal Delivery. AGOG Practice Bulletin No 154, November 2015
- 6 Operative Vaginal Delivery. RCOG Green-top Guideline No 26, January 2011 . Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_26.pdf . Accessed March 30, 2017
- 7 Goudar SS, Carlo WA, McClure EM. , et al. The Maternal and Newborn Health Registry Study of the Global Network for Women's and Children's Health Research. Int J Gynaecol Obstet 2012; 118 (03) 190-193
- 8 Maaløe N, Bygbjerg IC, Onesmo R, Secher NJ, Sorensen BL. Disclosing doubtful indications for emergency cesarean sections in rural hospitals in Tanzania: a retrospective criterion-based audit. Acta Obstet Gynecol Scand 2012; 91 (09) 1069-1076
- 9 Bogg L, Diwan V, Vora KS, DeCosta A. Impact of alternative maternal demand side financial support programs in India on cesarean sectiondelivery rates: indications of supplier-induced demand. Matern Child Health J 2016; 20 (01) 11-15
- 10 Akintayo AA, Ade-Ojo IP, Olagbuji BN, Akin-Akintayo OO, Ogundare OR, Olofinbiyi BA. Cesarean section on maternal request: the viewpoint of expectant women. Arch Gynecol Obstet 2014; 289 (04) 781-785
- 11 Mazzoni A, Althabe F, Gutierrez L. , et al. Women's preferences and mode of delivery in public and private hospitals: a prospective cohort study. BMC Pregnancy Childbirth 2016; 16: 34
- 12 Arsenault C, Fournier P, Philibert A. , et al. Emergency obstetric care in Mali: catastrophic spending and its impoverishing effects on households. Bull World Health Organ 2013; 91 (03) 207-216
- 13 Manasyan A, Saleem S, Koso-Thomas M. , et al; EmONC Trial Group. Assessment of obstetric and neonatal health services in developing country health facilities. Am J Perinatol 2013; 30 (09) 787-794
- 14 Gei AF. Prevention of the first cesarean delivery: the role of operative vaginal delivery. Semin Perinatol 2012; 36 (05) 365-373
- 15 Requejo JH, Belizán JM. Odon device: a promising tool to facilitate vaginal delivery and increase access to emergency care. Reprod Health 2013; 10: 42