Obstetrics and Gynecology

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Browsing Obstetrics and Gynecology by Author "Ashebir Getachew"

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    Cesearean Section Rates and Adverse Perinatal Outcomes Among Robsons Ten Groups Of Women: A Step Towards A Multidimensional Audit
    (Addis Ababa University, 2025-10-19) Berhan Habtom; Ashebir Getachew; Merga Negeri
    Background Cesarean section (CS) rates are rising globally, with wide variation across populations. The World Health Organization recommends the Robson classification system for standardized monitoring. However, little is known about its association with maternal morbidity and adverse perinatal outcomes (APO) in Ethiopian referral hospitals. Methods We conducted a hospital-based cross-sectional study among 1,100 deliveries across three referral hospitals in Addis Ababa. Deliveries were classified into the ten Robson groups. Maternal morbidity and APO (including low Apgar score, NICU admission, advanced resuscitation, stillbirth, and early neonatal death) were assessed. Logistic regression was applied to identify independent predictors of APO. Results Of the 1,100 deliveries, 566 (51.5%) were by CS. Groups 5 (32.2%), 1 (18.9%), 2 (10.6%), 3(9.4) and 10 (8.8%) were the largest contributors. Maternal morbidity occurred in 25.8% of CS deliveries, highest in Group 10 (68.0%) and Group 4 (55.9%). The overall APO rate was 19.3%, with Group 10 (56.0%), Group 6 (47.6%), and Group 8 (36.7%) most affected. In multivariable regression, gestational age was protective (AOR 0.83 per week, 95% CI 0.75–0.92, p<0.001), while hypertensive disorders with intrauterine growth restriction (HDP with IUGR) (AOR 6.19, 95% CI 2.34–16.38, p<0.001) and residence outside Addis Ababa (AOR 4.51, 95% CI 1.35 15.07, p=0.02) were significant predictors of APO. Conclusion The study demonstrates that high CS rates alone do not equate to poor or good outcomes. Instead, prematurity, HDP with IUGR, and delayed referral drive adverse results. Robson Groups 10, 6, and 8 carried the greatest perinatal risks, while Groups 4 and 10 had the highest maternal morbidity. Implementing Robson-based CS audits, strengthening antenatal surveillance for HDP and IUGR, and improving neonatal care and referral systems are critical to reducing adverse outcomes.
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    Magnitude of long-acting reversible contraceptive use and associated factors after elective Cesarean delivery at three teaching hospitals of Addis Ababa: A cross sectional hospital-based study 2025.
    (Addis Ababa University, 2025) Adugnaw Getachew; Abera Bedada; Ashebir Getachew
    Background: - Cesarean Section (CS) deliveries are becoming increasingly common worldwide, and women who deliver via CS may have unique contraceptive needs and preferences. The immediate postpartum period, particularly during the period of hospital stay following an elective CS, presents a valuable opportunity to counsel and initiate long-acting reversible contraception. Objective: To evaluate the use and utilization of immediate postpartum long-acting reversible contraceptive methods and associated factors among pregnant women who gave birth by elective CS in the three teaching hospitals of Addis Ababa. Methods: A facility-based cross-sectional study design was conducted, and 422 post-elective CS-delivered women were planned by a systematic random sampling method from those delivered by elective cesarean section. Data were collected using a structured questionnaire and entered and analyzed by SPSS version 25 for further analysis. The impact for the uptake of LARC was measured by logistic regression. Those variables having a 𝑃-value < 0.25 in the bivariate logistic analysis were entered into the multivariate logistic regression model to identify the association of independent variables with the outcome variable. In the multivariable analysis, a 𝑃 value of < 0.05 was used to declare the statistical significance, and AOR with 95% CI was calculated to determine association. Results: - Only 22.9% of participants were using immediate postpartum LARCs. Among users (n=95), Implanon was the most common method (64.2%), followed by IUCDs (20%) and Jadelle (15.8%). Multivariate analysis showed that women residing in rural areas were 3.8 times more likely to use LARCs compared to those in urban areas (AOR = 3.8, 95% CI: 1.88–16.57). Women with a college education or higher had 3.1 times higher odds of LARC use compared to those who were illiterate (AOR = 3.1, 95% CI: 1.41–23.56). Additionally, larger family size (>4 members) (AOR = 6.3), grand multiparty (AOR = 8.8), being the main decision-maker for contraception (AOR = 9.6), and having a favorable attitude toward LARCs (AOR = 20.2) were all significantly associated with increased postpartum LARC use. Conclusion: The utilization of immediate postpartum LARCs was low despite their proven benefits. Strengthening education, male involvement, counseling services, and addressing misconceptions are critical to improving postpartum LARC uptake