Trends in the Mode of Delivery of Pregnant Women in Rural Guatemala from a Quality Improvement Database
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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.
KeywordsVaginal delivery Cesarean delivery Nulliparous term singleton vertex Guatemala Pregnancy
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 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
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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