Am J Perinatol 2019; 36(07): 730-736
DOI: 10.1055/s-0038-1673656
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Prospective, Population-Based Study of Trends in Operative Vaginal Delivery Compared to Cesarean Delivery Rates in Low- and Middle-Income Countries, 2010–2016

Margo S. Harrison
1  University of Colorado School of Medicine, Denver, Colorado
,
Sarah Saleem
2  Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
,
Sumera Ali
2  Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
,
Omrana Pasha
2  Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
,
Elwyn Chomba
3  University Teaching Hospital, University of Zambia, Lusaka, Zambia
,
Waldemar A. Carlo
4  University of Alabama at Birmingham, Birmingham, Alabama
,
Ana L. Garces
5  Unidad de Planificación Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala City, Guatemala
,
Nancy F. Krebs
1  University of Colorado School of Medicine, Denver, Colorado
,
K. Michael Hambidge
1  University of Colorado School of Medicine, Denver, Colorado
,
Shivaprasad S. Goudar
6  KLE University's Jawaharlal Nehru Medical College, Belgaum, India
,
S. M. Dhaded
6  KLE University's Jawaharlal Nehru Medical College, Belgaum, India
,
Bhala Kodkany
6  KLE University's Jawaharlal Nehru Medical College, Belgaum, India
,
Richard J. Derman
7  Thomas Jefferson University, Philadelphia, Pennsylvania
,
Archana Patel
8  Lata Medical Research Foundation, Nagpur, Maharashtra, India
,
Patricia L. Hibberd
9  Boston University, Boston, Massachusetts
,
Fabian Esamai
10  Moi University School of Medicine, Eldoret, Kenya
,
Edward A. Liechty
11  Indiana University School of Medicine, Indianapolis, Indiana
,
Antoinette Tshefu
12  Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
,
Adrien Lokangaka
12  Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
,
Melissa Bauserman
13  Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
,
Carl L. Bose
13  Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
,
Fernando Althabe
14  Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
,
Jose M. Belizan
14  Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
,
Pierre Buekens
15  Tulane School of Public Health and Tropic Medicine, New Orleans, Louisiana
,
Janet L. Moore
16  RTI International, Durham, North Carolina
,
Dennis D. Wallace
16  RTI International, Durham, North Carolina
,
Menachem Miodovnik
17  Eunice Kennedy Shriver , National Institute of Child Health and Human Development, Rockville, Maryland
,
Marion Koso-Thomas
17  Eunice Kennedy Shriver , National Institute of Child Health and Human Development, Rockville, Maryland
,
Elizabeth M. McClure
16  RTI International, Durham, North Carolina
,
Robert L. Goldenberg
18  Department of Obstetrics/Gynecology, Columbia University, New York, New York
› Author Affiliations
Funding 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.
Further Information

Publication History

14 March 2018

01 September 2018

Publication Date:
29 October 2018 (online)

Abstract

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.

Condensation

OVD (forceps- and vacuum-assisted vaginal delivery) is decreasing in the LMICs, while cesarean delivery rates are increasing.


Authors' Contributions

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.