Prediction of Emergency Cesarean Section Using Detectable Maternal and Fetal Characteristics Among Saudi Women

Hayfaa Wahabi; Amel Fayed; Hala Elmorshedy; Samia Ahmad Esmaeil; Yasser S Amer; Elshazaly Saeed; Amr Jamal; Sarah A Aleban; Reema Abdullah Aldawish; Lara Sabri Alyahiwi; Haya Abdullah Alnafisah; Raghad E AlSubki; Norah Khalid Albahli; Aljohara Ayed Almutairi

doi:10.2147/IJWH.S414380

Prediction of Emergency Cesarean Section Using Detectable Maternal and Fetal Characteristics Among Saudi Women

Int J Womens Health. 2023 Aug 8:15:1283-1293. doi: 10.2147/IJWH.S414380. eCollection 2023.

Authors

Hayfaa Wahabi^{1

2}, Amel Fayed³, Hala Elmorshedy³, Samia Ahmad Esmaeil^{1

2}, Yasser S Amer^{1

4}, Elshazaly Saeed⁵, Amr Jamal^{1

2}, Sarah A Aleban³, Reema Abdullah Aldawish³, Lara Sabri Alyahiwi³, Haya Abdullah Alnafisah³, Raghad E AlSubki³, Norah Khalid Albahli³, Aljohara Ayed Almutairi³

Affiliations

¹ Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia.
² Department of Family and Community Medicine, King Saud University Medical City and College of Medicine, Riyadh, Saudi Arabia.
³ Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
⁴ Clinical Practice Guidelines Unit, Quality Management Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
⁵ Prince Abdulla bin Khaled Coeliac Disease Research Chair, King Saud University, Riyadh, Saudi Arabia.

Abstract

Background: The worldwide rate of cesarean section (CS) is increasing. Development of prediction models for a specific population may improve the unmet need for CS as well as reduce the overuse of CS.

Objective: To explore risk factors associated with emergency CS, and to determine the accuracy of predicting it.

Methods: A retrospective analysis of the medical records of women who delivered between January 1, 2021-December 2022 was conducted, relevant maternal and neonatal data were retrieved.

Results: Out of 1793 deliveries, 447 (25.0%) had emergency CS. Compared to control, the risk of emergency CS was higher in primiparous women (OR 2.13, 95% CI 1.48 to 3.06), in women with higher Body mass index (BMI) (OR 1.77, 95% CI 1.27 to 2.47), in association with history of previous CS (OR 4.81, 95% CI 3.24 to 7.15) and in women with abnormal amniotic fluid (OR 2.30, 95% CI 1.55 to 3.41). Additionally, women with hypertensive disorders had a 176% increased risk of emergency CS (OR 2.76, 95% CI 1.35-5.63). Of note, the risk of emergency CS was more than three times higher in women who delivered a small for gestational age infant (OR 3.29, 95% CI 1.93-5.59). Based on the number of risk factors, a prediction model was developed, about 80% of pregnant women in the emergency CS group scored higher grades compared to control group. The area under the curve was 0.72, indicating a good discriminant ability of the model.

Conclusion: This study identified several risk factors associated with emergency CS in pregnant Saudi women. A prediction model showed 72% accuracy in predicting the likelihood of emergency CS. This information can be useful to individualize the risk of emergency CS, and to implement appropriate measures to prevent unnecessary CS.

Keywords: Saudi Arabia; emergency cesarean section; indications; prediction.

Grants and funding

This project was funded by Princess Nourah bint Abdulrahman university researchers supporting project (number PNURSP2022R21) Princess Nourah bint Abdulrahman university, Riyadh, Saudi Arabia.