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Trends in the Mode of Delivery of Pregnant Women in Rural Guatemala from a Quality Improvement Database

  • Margo S. HarrisonEmail author
  • Sharon Scarbro
  • Elizabeth Juarez-Colunga
  • Andrea Jimenez-Zambrano
  • Saskia Bunge-Montes
  • Guillermo A. Bolaños
  • Molly Lamb
  • Edwin J. Asturias
  • Stephen Berman
  • Gretchen Heinrichs
From the Field
  • 13 Downloads

Abstract

Purpose To evaluate trends and factors associated with mode of delivery in the rural Southwest Trifinio region of Guatemala. Description We conducted a retrospective analysis of self-reported antepartum factors and postpartum outcomes recorded in a quality improvement database among 430 women enrolled in a home-based maternal healthcare program between June 1, 2015 and August 1, 2017. Assessment Over the study period, the rates of cesarean delivery (CD) increased (from 30 to 45%) and rates of vaginal delivery (VD) decreased (70–55%) while facility-based delivery attendance remained stable around 70%. Younger age (23.5 years for VD vs. 21.6 years for CD, p < 0.001), nulliparity (25.1% for VD vs. 45.0% for CD, p < 0.001), prolonged/obstructed labor (2.4% for VD vs. 55.6% for CD, p < 0.001), and fetal malpresentation (0% for VD vs. 16.3% CD, p < 0.001) significantly influenced mode of delivery in univariate analysis. The leading indications for CD were labor dysfunction (47.5%), malpresentation (14.5%), and prior cesarean delivery (19.8%). The CD rate among the subpopulation of term, nulliparous women with singleton pregnancies in vertex presentation also increased from 20% of all CD in 2015, to 38% in 2017. Conclusion Among low-income women from rural Guatemala, the CD rate has increased above the World Health Organization (WHO) recommendations in a period of 3 years. Additional research on the factors affecting this trend are essential to guide interventions that might improve the appropriateness of CD, and to determine if reducing or stabilizing rates is necessary.

Keywords

Vaginal delivery Cesarean delivery Nulliparous term singleton vertex Guatemala Pregnancy 

Notes

Acknowledgements

We wish to sincerely thank each nurse working in the Madres Sanas program who collected the data and provided such high quality maternal healthcare to the community (Claudia Rivera, Yoselin Velasquez, Karen Altun, Silivia Aragon, Alisse Hernandez, Cristal Gonzalez, Alba Gabriel, Dulce Gramajo), and the community leaders and women who participated in the program.

Funding

Funding for the Madres Sanas Program was provided by a donation from Agroamerica and the Jose Fernando Bolanos Foundation and by the NICHD WRHR K12 Program (Grant No. 5K12HD001271-18).

Compliance with Ethical Standards

Ethical Approval

This study was deemed non-human subjects’ quality improvement by Colorado Multiple Institutional Review Board (COMIRB). This secondary analysis of a de-identified subset of the database was approved by COMIRB, #17-1941.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Margo S. Harrison
    • 1
    • 2
    • 7
    Email author return OK on get
  • Sharon Scarbro
    • 3
  • Elizabeth Juarez-Colunga
    • 3
  • Andrea Jimenez-Zambrano
    • 2
    • 3
  • Saskia Bunge-Montes
    • 3
    • 4
  • Guillermo A. Bolaños
    • 4
  • Molly Lamb
    • 2
    • 5
  • Edwin J. Asturias
    • 2
    • 5
    • 6
  • Stephen Berman
    • 2
    • 5
    • 6
  • Gretchen Heinrichs
    • 1
    • 2
  1. 1.Department of Obstetrics and GynecologyUniversity of Colorado School of MedicineAuroraUSA
  2. 2.Center for Global HealthColorado School of Public HealthAuroraUSA
  3. 3.Adult and Child Consortium for Health Outcomes Research and Delivery ScienceUniversity of Colorado School of MedicineAuroraUSA
  4. 4.Center for Human DevelopmentFundacion para la Salud Integral de los Guatemaltecos, FunsaludRetalhuleuGuatemala
  5. 5.Department of EpidemiologyColorado School of Public HealthAuroraUSA
  6. 6.Department of PediatricsUniversity of Colorado School of MedicineAuroraUSA
  7. 7.Department of Obstetrics and GynecologyUniversity of ColoradoAuroraUSA

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