Elective versus non-elective caesarean sections: A multinomial regression analysis of predictors and foetal outcome in a Tertiary Health Facility in Southwestern Nigeria

Objective: This study assessed the demographic and obstetric predictors of elective and non-elective caesarean section and the fetal outcomes at Babcock University Teaching Hospital (BUTH). Methods: A cross-sectional study of 447 pregnant women who delivered between August 2020 and February 2022 at BUTH. Statistical analysis was done using IBM-SPSS version 23.0. Multinomial logistic regression analysis was used to identify specific predictors of both elective and non-elective caesarean sections. Results: We found that being aged 30 years and older (AOR 2.5 CI 1.3-5.0; p: 0.007), having low birth order [(order 1, AOR 3.4 CI 1.4-8.3; p: 0.008), (order 2, AOR 2.5 CI 1.1-5.8; p: 0.027)], history of CS (AOR 200.8 CI 56.3-716.9; p: <0.001) and non-cephalic foetal presentation (AOR 61.9 CI 7.2-529.7; p: <0.001) predicted elective CS delivery while low birth order (order 1, AOR 3.6 CI 1.8-7.1; p: <0.001), gestational age between 37 and 40 weeks (AOR 3.7 CI 1.6-8.4; p: 0.002) and history of CS (AOR 22.3 CI 6.0-82.1; p: <0.001) predicted non-elective CS. Foetal morbidities such as birth asphyxia, prematurity and low birth weight were significantly higher in women who had non-elective CS. Conclusion: This study has demonstrated that advanced maternal age, low birth order, history of CS and non-cephalic presentation predicted elective CS, while low birth order, history of CS and gestational age 37-40 weeks predicted non-elective CS. Advocacy for early commencement of family planning and having well-justified indications for the first CS may be useful strategies for optimizing caesarean delivery at the facility level in Nigeria.