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Am J Perinatol. 2019 Jun;36(7):730-736. doi: 10.1055/s-0038-1673656. Epub 2018 Oct 29.

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

Author information

1
University of Colorado School of Medicine, Denver, Colorado.
2
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
3
University Teaching Hospital, University of Zambia, Lusaka, Zambia.
4
University of Alabama at Birmingham, Birmingham, Alabama.
5
Unidad de Planificación Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala City, Guatemala.
6
KLE University's Jawaharlal Nehru Medical College, Belgaum, India.
7
Thomas Jefferson University, Philadelphia, Pennsylvania.
8
Lata Medical Research Foundation, Nagpur, Maharashtra, India.
9
Boston University, Boston, Massachusetts.
10
Moi University School of Medicine, Eldoret, Kenya.
11
Indiana University School of Medicine, Indianapolis, Indiana.
12
Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo.
13
Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
14
Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
15
Tulane School of Public Health and Tropic Medicine, New Orleans, Louisiana.
16
RTI International, Durham, North Carolina.
17
National Institute of Child Health and Human Development, Rockville, Maryland.
18
Department of Obstetrics/Gynecology, Columbia University, New York, New York.

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.

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