Abstract

Objectives: To determine the rate of cesarean section (CS) in Jordan and its causes, associated factors, and neonatal outcomes.

Methods: The study is part of a comprehensive national study of perinatal mortality which was conducted between 2011 and 2012 in Jordan. The study was concurrent prospective in design. A sample of 18 hospitals with maternity departments was selected. All women = 20 weeks of gestation admitted for delivery in any of the 18 selected hospitals were enrolled in the study. Data were collected by interviews and abstraction of data from medical records.

Results: The overall rate of CS was 29.1% (13.2% as emergency CS and 15.9% as planned CS). Health sector, income of >350, <12 years of education, increased gestational age at delivery, primiparity, previous CS, male gender, overweight, obesity, pre-gestational and gestational diabetes, non-cephalic presentation, multiple pregnancy, preeclampsia, anemia, smoking, history of neonatal death/stillbirth, and previous hospitalization during current pregnancy were all associated with increased odds of CS in the multivariate analysis. The most frequent reason for planned CS was scarred uterus (59.4%) and for emergency CS was prolonged fetal distress (30.0%). The neonatal death rate was significantly higher (p=0.000) for planned CS (2.1%) and emergency CS (2.5%) as compared to vaginal delivery (0.9%).

Conclusion: The rate of CS in Jordan is high (29.1%). CS is associated with increased risk of neonatal death. As most CSs are currently based on physician’s judgment, it may be extremely useful to develop and implement national guidelines for performing CS. Obstetricians’ adherence to these guidelines should be strictly monitored.