Sociodemographic and Obstetric Determinants of Modes of Delivery among Women delivered in a Nigerian Tertiary Hospital.

Abstract

Introduction: Maternal and perinatal morbidity and mortality are high in our environment. This can be prevented by skilled attendance at birth when decisions on the best mode of delivery may depend on the parturient’s sociodemographic and obstetric
factors at presentation. Methodology: This was a 5-year retrospective study of all women who delivered in the University of Uyo Teaching Hospital. The sociodemographic and obstetric characteristics and mode of delivery were extracted and analyzed. Descriptive
statistics, Fischer`s exact test and multiple logistic regression were used to analyze relationships between variables and significance was set at P-value less than 0.05. Results: There were a total of 6758 deliveries:3939 (58.3%) had Spontaneous vaginal delivery, 2671(39.5%) had caesarean section while 2.2% had instrumental delivery. The majority, 5696 (84.0%) of the women were aged 18 to 34years (mean 29years±4.7S.D.) The fetal presentation, (P < 0.0001), booking status (P <0.0001), gestational age (P <0.0001), birthweight (P value<0.0001).and maternal age (P <0.0001).were significantly associated with mode of delivery; while their parity (P =0.313) and the sex of their babies (P =0.1000) had no significant association with the modes of delivery. Determinants of
instrumental delivery were booking(OR=0.55, P value<0.0001), condition of the baby: live compared to still birth (OR=1.5, 1.13-1.97), High APGAR score (OR=0.56, 0.47- 0.69) presentation Breech,Oblique, Transverse OR=9.71 CI=6.9-13.7), OR=9.21 CI 2.0-
41.6, OR= 33.2 CI= 8.0-137.3 compared to cephalic. Conclusions: The mode of delivery is influenced significantly by obstetrics and socio-demographic factors which may exist singly or in combination. This can be exploited by the skilled birth attendant in decision
making and patient counselling about the odds for and against a mode of delivery at presentation and during management in the delivery suite.