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. 2019 Apr;23(4):435-442.
doi: 10.1007/s10995-018-2655-2.

Trends in the Mode of Delivery of Pregnant Women in Rural Guatemala from a Quality Improvement Database

Margo S Harrison  1   2   3 , Sharon Scarbro  4 , Elizabeth Juarez-Colunga  4 , Andrea Jimenez-Zambrano  5   4 , Saskia Bunge-Montes  4   6 , Guillermo A Bolaños  6 , Molly Lamb  5   7 , Edwin J Asturias  5   7   8 , Stephen Berman  5   7   8 , Gretchen Heinrichs  9   5
Affiliations

Trends in the Mode of Delivery of Pregnant Women in Rural Guatemala from a Quality Improvement Database

Margo S Harrison et al. Matern Child Health J. 2019 Apr.

Abstract

Purpose To evaluate trends and factors associated with mode of delivery in the rural Southwest Trifinio region of Guatemala. Description We conducted a retrospective analysis of self-reported antepartum factors and postpartum outcomes recorded in a quality improvement database among 430 women enrolled in a home-based maternal healthcare program between June 1, 2015 and August 1, 2017. Assessment Over the study period, the rates of cesarean delivery (CD) increased (from 30 to 45%) and rates of vaginal delivery (VD) decreased (70-55%) while facility-based delivery attendance remained stable around 70%. Younger age (23.5 years for VD vs. 21.6 years for CD, p < 0.001), nulliparity (25.1% for VD vs. 45.0% for CD, p < 0.001), prolonged/obstructed labor (2.4% for VD vs. 55.6% for CD, p < 0.001), and fetal malpresentation (0% for VD vs. 16.3% CD, p < 0.001) significantly influenced mode of delivery in univariate analysis. The leading indications for CD were labor dysfunction (47.5%), malpresentation (14.5%), and prior cesarean delivery (19.8%). The CD rate among the subpopulation of term, nulliparous women with singleton pregnancies in vertex presentation also increased from 20% of all CD in 2015, to 38% in 2017. Conclusion Among low-income women from rural Guatemala, the CD rate has increased above the World Health Organization (WHO) recommendations in a period of 3 years. Additional research on the factors affecting this trend are essential to guide interventions that might improve the appropriateness of CD, and to determine if reducing or stabilizing rates is necessary.

Keywords: Cesarean delivery; Guatemala; Nulliparous term singleton vertex; Pregnancy; Vaginal delivery.

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Figures

Figure 1.
Figure 1.
CONSORT Diagram of Women from the SW Trifinio Included and Excluded from the Analysis
Figure 2.
Figure 2.
Trends in Method of Delivery in the SW Trifinio Region of Guatemala, 2015 – 2017. Unadjusted percents and 95% confidence intervals.
Figure 3.
Figure 3.
Facility-Based Deliveries and the Proportion of all Deliveries that were Delivered by Cesarean Section, 2015 – 2017.
See this image and copyright information in PMC

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