Preterm Birth Among Intrapartum Cesarean Deliveries at Public Hospitals in Southern Ethiopia: A Multicenter Retrospective Analysis of Risk Factors

PURPOSE: Although the underlying causes for preterm birth are thought to be multifactorial irrespective of delivery mode, no study investigated its risk factors amongst cesarean deliveries (CD). Thus, we aimed to identify potential risk factors for the occurrence of preterm birth (PTB) among intrapartum CD. METHODS: Data from 1659 singleton intrapartum CDs were retrospectively recruited using medical records and an obstetric database. Gestational age was calculated using the last menstrual period (LMP) and ultrasound report of early onset pregnancy. A multivariable logistic regression analysis was performed to identify potential risk factors associated with PTB. Odds ratios (ORs) and 95% confidence intervals (95% CI) were used. Statistical analysis was performed using SPSS version 26.0. RESULTS: In this study, the prevalence of PTB among intrapartum CD was 6.1% (95% CI: 4.9, 7.2%). In the multivariable logistic regression model; grand parity ≥5 (adjusted odds ratio (AOR) = 2.43, 95% CI: 1.72–4.73), maternal age <20 years (AOR=2.63, 95% CI, 1.03–6.71), maternal age ≥35 years (AOR=3.83, 95% CI, 1.49–5.35), cesarean section scar ≥2 (AOR=4.86, 95% CI: 2.68–8.94), antepartum hemorrhage (AOR=4.37, 95% CI: 2.22–8.63), pregnancy-induced hypertension (AOR=2.92, 95% CI: 1.41–6.04), and premature rupture of membranes (AOR=4.56; 95% CI: 1.95–10.65) were significantly associated with PTB. CONCLUSION: The current study showed an association between PTB and a multitude of obstetric variables, including grand parity ≥5, CS scar ≥2, antepartum hemorrhage, pregnancy-induced hypertension, and premature rupture of the membrane. Understanding these factors could help to implement improved quality of obstetric and neonatal care to increase survival and reduce morbidity among preterm birth.