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*Ghaida'a Ali Alharbi, Hanan Mosleh, Emtinan Mohammad Alruhaili, Amal Muflih Alqurafi, Amna Ibrahim Madkhali, Maryam Abdullah Almubarak, Leema Khalid Alhussayen and Ahdab Mohammed Aljohani


Background: The rate of caesarean section (CS) has significantly increased worldwide during the last few decades. The Saudi literature, however, showed paucity of data about its rate and reasons in the Kingdom. Objectives: To determine the prevalence of CS among primi mothers in Madinah city, Saudi Arabia, and to investigate causes related to maternal request for CS versus medically indicated CS deliveries over time. Methods: A web-based cross-sectional study was conducted in Madinah city, Saudi Arabia from October to December 2017. The study analyzed data from 390 women lived in Madinah city. The data were collected through questionnaires distributed electronically which consisted of sociodemographic data and obstetric history data about year of first birth, age at first birth, type of hospital, type of delivery at first birth (vaginal or caesarian), reasons of CS whether it is due to maternal request or medically indicated, and outcome of pregnancy. The collected data were analyzed using appropriate statistical methods. The level of statistical significance was defined as P ≤ 0.05. Results: The mean age of the studied women was 29.1 ± 5.4 years. Out of the studied 390 women, the prevalence of CS was 56.7% (221/390 (95% CI= 51.7%- 61.6%)). Of them, 13 women (5.9%) reported CS on request. The main medical reasons for CS were cephalo-pelvic disproportion (17.2%), malpresentation of the fetus (16.8%), preeclampsia (11.8%), and cervical spasm (11.3%). On request CS was significantly more among women < 25 years (9.4%; p = 0.03). Although not significant, CS on request was also higher among highly educated women (11.8%), women with medical insurance (9.3%), and monthly income ≥10,000 SR (7.2%). None of the studied women before 2005 had reported CS on request, and all maternal requests for CS were after 2005, and it was representing 6.9% of all caesarean sections between 2005 and 2016. Conclusions: The study revealed a high rate of CS in Madinah city, Saudi Arabia. CS on request represented 6.5% of all CS between 2005 and 2016, and it was higher among young, highly educated, and women with high monthly income and medical insurance. An appropriate strategy has to be considered by health authority to reduce unnecessary CS delivery in Madinah city.

Keywords: Caesarean section, Reasons, Maternal, Request, Saudi Arabia.

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