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Risk assessment for obstetric interventions.

AIM
This study was conducted to reveal the determinants of obstetric interventions in El Shatby maternity hospital, the only obstetric care facility providing tertiary care in Alexandria


METHODS
Parturient admitted to the delivery room during the morning and afternoon shifts between April and February 2002 were enrolled in the study. Data were obtained by interview questionnaire complemented by thorough obstetric examination and close monitoring of the labor progress. Data were analyzed using the univariate and multivariate regression analyses.


RESULTS
out of the 3201 parturient who attended the hospital, 1302 were included in the study. Nearly three-fifths (61.7%) of parturient had a vaginal delivery. For the remaining proportion, delivery was accomplished by an elective (20.3%) or emergency (17.1%) cesarean section while few (0.9%) had an instrumental vaginal delivery. Operative obstetric intervention was determined by both maternal and fetal factors. For both primiparae and multiparae, the risk of elective cesarean delivery was independently predicted by abnormal fetal presentation, signs of fetal distress, toxemia of pregnancy and frequent antenatal visits of more than four. In addition, it is independently predicted by post date for primiparae and prolonged rupture of the membranes, history of still birth as well as previous obstetric intervention for multiparae. As for emergency cesarean delivery, it is independently predicted by prolonged rupture of the membrane, signs of fetal distress, ante-partum hemorrhage in both primiparae and multiparae. In addition, for primiparae, it is independently predicted by abnormal fetal presentation and a birth weight of more than 3500 grams while for multiparae, it is predicted by previous obstetric intervention as well as the non use of contraception following the delivery of the previous child.


CONCLUSION
Both elective and emergency cesarean deliveries are independently predicted by fetal as well as maternal factors, though a proportion may not be medically justified considering models' predictive value. The extent of obstetric interventions reflects only that of specialized tertiary facility. There is a need for an extensive study including different level of health facilities in order to illustrate the whole scope of obstetric intervention and to develop a better understanding of its determinants.