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Differences in rates and odds for emergency caesarean section in six Palestinian hospitals: a population-based birth cohort study
  1. Mohammed Zimmo1,2,3,
  2. Katariina Laine4,5,
  3. Sahar Hassan6,
  4. Erik Fosse2,3,
  5. Marit Lieng2,7,
  6. Hadil Ali-Masri2,3,8,
  7. Kaled Zimmo2,3,9,
  8. Marit Anti10,
  9. Bettina Bottcher11,
  10. Ragnhild Sørum Falk12,
  11. Åse Vikanes3
  1. 1 Obstetrics Department, Al Shifa Hospital, Gaza, Palestine
  2. 2 Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
  3. 3 Intervention Centre, Oslo University Hospital Rikshospitalet, Oslo, Norway
  4. 4 Department of Obstetrics, Oslo University Hospital, Ullevål, Oslo, Norway
  5. 5 Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
  6. 6 Faculty of Pharmacy, Nursing, and Health Professions, Birzeit University, Birzeit, Palestine
  7. 7 Department of Gynecology, Oslo University Hospital, Oslo, Norway
  8. 8 Obstetrics Department, Palestine Medical Complex, West Bank, Palestine
  9. 9 Obstetrics Department, Al Aqsa Hospital, Gaza, Palestine
  10. 10 Biostatistics Department, Oslo School of Management, Oslo, Norway
  11. 11 Faculty of Medicine, Islamic University, Gaza, Palestine
  12. 12 Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
  1. Correspondence to Dr Mohammed Zimmo; mohammedzimmo1983{at}gmail.com

Abstract

Objective To assess the differences in rates and odds for emergency caesarean section among singleton pregnancies in six governmental Palestinian hospitals.

Design A prospective population-based birth cohort study.

Setting Obstetric departments in six governmental Palestinian hospitals.

Participants 32 321 women scheduled to deliver vaginally from 1 March 2015 until 29 February 2016.

Methods To assess differences in sociodemographic and antenatal obstetric characteristics by hospital, χ2 test, analysis of variance and Kruskal-Wallis test were applied. Logistic regression was used to estimate differences in odds for emergency caesarean section, and ORs with 95% CIs were assessed.

Main outcome measures The primary outcome was the adjusted ORs of emergency caesarean section among singleton pregnancies for five Palestinian hospitals as compared with the reference (Hospital 1).

Results The prevalence of emergency caesarean section varied across hospitals, ranging from 5.8% to 22.6% among primiparous women and between 4.8% and 13.1% among parous women. Compared with the reference hospital, the ORs for emergency caesarean section were increased in all other hospitals, crude ORs ranging from 1.95 (95% CI 1.42 to 2.67) to 4.75 (95% CI 3.49 to 6.46) among primiparous women. For parous women, these differences were less pronounced, crude ORs ranging from 1.37 (95% CI 1.13 to 1.67) to 2.99 (95% CI 2.44 to 3.65). After adjustment for potential confounders, the ORs were reduced but still statistically significant, except for one hospital among parous women.

Conclusion Substantial differences in odds for emergency caesarean section between the six Palestinian governmental hospitals were observed. These could not be explained by the studied sociodemographic or antenatal obstetric characteristics.

  • maternal medicine
  • obstetrics
  • prenatal diagnosis

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors MZ: in charge of data collection, participated in staff training on data registration and entry, statistical analysis for the data set and drafted the manuscript. KL: study design, protocol and research tool development, participated in staff training on data registration and entry, and drafted the manuscript. SH: study design, collaborated in the preparation of the protocol and research tool development, data collection, participated in staff training on data registration and entry, and commented on the manuscript. EF: study design, protocol development and commented on the manuscript. ML: commented on the manuscript. KZ and HA-M: data collection, participated in staff training on data registration and entry, and commented on the manuscript. MA: commented on the manuscript. BB: revised the medical English language and commented on the manuscript. RSF: statistical analysis for the data set and commented on the manuscript. AV: study design, protocol and research tool development, participated in staff training on data registration and entry, and commented on the manuscript. All authors had full access to all the data in the study and can take responsibility for the integrity and accuracy of the data analysis and they had final responsibility for the decision to submit for publication.

  • Funding This work was supported by the Norwegian Research Council through Oslo University Hospital (234452/14).

  • Disclaimer The funding source had no role in the study design, data collection, data analysis, data interpretation or writing of the manuscript.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval This study was approved by the Norwegian Data Inspectorate (17/00082-2/GRA) and the Regional Committee for Medical and Health Research Ethics in South-Eastern Norway and was considered as health quality research (REK 2014/1727). Oslo University Hospital signed an agreement with the Palestinian Ministry of Health, which approved conducting the study within their facilities. The project was done in accordance with common rules for healthcare services in Palestine and Norway regarding confidentiality and privacy.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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