Modifiable Risk Factors and their Individual Contribution to Caesarean Delivery
DOI:
https://doi.org/10.51985/Keywords:
Advanced maternal age; Antenatal care; Caesarean section; Maternal request; ObesityAbstract
Objective: To determine the frequency of modifiable factors and identify their associated determinants among women undergoing caesarean section.
Study design and setting: A cross-sectional study conducted at Ziauddin hospital, Karachi.
Methodology: Consecutive women undergoing Caesarean section (CS) were included. Modifiable factors leading to CS such as maternal request, obesity and advanced maternal age were recorded. Chi-square test was used to measure associations between modifiable factors and sociodemographic factors. The multivariate logistic regression analysis was conducted to reveal independent predictors. A p-value =0.05 was considered statistically significant.
Results: The leading modifiable factor observed was obesity (40.7%) followed by advanced maternal age (18%) and maternal request (12.0%). Higher educational status, family income, antenatal care visits and booking status were significantly linked to maternal request (p<0.05). Family income and parity was significantly associated with obesity and advanced maternal age was linked with education, income and booking status. In multivariate analysis, increased antennal care visits were independent predictors of maternal request (AOR=2.97, p=0.039), whereas increased family income was an independent predictor of advanced maternal age (AOR=1.99, p=0.027).
Conclusion: Modifiable factors contribute substantially to Caesarean delivery. The use of the antenatal care and socioeconomic status are vital and point to the necessity of specific counseling and preventive measures
Downloads
References
1. Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and
projections of caesarean section rates: global and regional
estimates. BMJ Glob Health. 2021;6(6):e005671.
doi:10.1136/bmjgh-2021-005671
2. de Vries BS, Morton R, Burton AE, Kumar P, Hyett JA,
Phipps H, McGeechan K. Attributable factors for the rising
Caesareans delivery rate over 3 decades: an observational
cohort study. Am J Obstet Gynecol MFM. 2022;4(2):100555.
doi:10.1016/j.ajogmf.2021.100555
3. Sayed G, Salama H, Abumhara S, Al-Obaidly S, Al-Qubaisi
M, Al-Rifai H. Review of socioeconomic risk factors for
Caesareans births: a population-based study. Acta Biomed.
2023;94(3):e2023082. doi:10.23750/abm.v94i3.14825
4. Pavlidou E, Antasouras G, Papadopoulou SK, Alexatou O,
Papandreou D, Mentzelou M, et al. Association of maternal
risk factors with the prevalence of caesarean section deliveries:
a cross-sectional study. Med Sci. 2023;11(4):66. doi:10.
3390/medsci11040066
5. Brizan JB, Amabebe E. Maternal obesity as a risk factor for
caesarean delivery in sub-Saharan Africa: a systematic review.
Life (Basel). 2022;12(6):906. doi:10.3390/life12060906
6. Tun MH, Chari R, Kaul P, Mamede FV, Paulden M, Lefebvre
DL, et al. Prediction of odds for emergency Caesarean: a
secondary analysis of the CHILD term birth cohort study.
PLoS One. 2022;17(10):e0268229. doi:10.1371/ journal.pone.
0268229
7. Alonso-Colón M, Pérez-Gómez B, Ramis R. Determinants
of Caesarean rates: A cross-sectional study of 4.9 million
deliveries over 10 years. Eur J Obstet Gynecol Reprod Biol.
2025;312:114527. doi:10.1016/j.ejogrb.2025.114527
8. Giang HT, Duy DT, Hieu LT, Vuong NL, Ngoc NT, Phuong
MT, et al. Factors associated with the very high caesarean
section rate in urban areas of Vietnam. PLoS One. 2022;17(8):
e0273127. doi:10.1371/journal.pone.0273127
9. Amjad A, Imran A, Shahram N, Zakar R, Usman A, Zakar
MZ, et al. Trends of caesarean section deliveries in Pakistan:
secondary data analysis from Demographic and Health
Surveys, 1990–2018. BMC Pregnancy Childbirth.
2020;20:753. doi:10.1186/s12884-020-03355-8
10. Shifa N, Bari A, Bukhari NA, Hayat Z, Jabeen R, Tabassum
H. Identify Modifiable factors and their individual contribution
to caesarean delivery. J Soc Obstet Gynaecol Pak. 2024;14(2):
244-8.
11. Haider G, Zehra N, Munir AA, Haider A. Frequency and
indications of caesarean section in a tertiary care hospital.
Pak J Med Sci. 2009;25(5):791-6.
12. Zeeshan M, Iqbal A, Rasul S, Shahzad I, Ashraf S, Akbar A.
Prevalence and associated factors of caesarean section in
Punjab. Pak J Med Res. 2021;60(2):62-8.
13. Majid E, Kulsoom S, Fatima S, Zuberi BF. Rising caesarean
section rates using Robson classification: A tertiary care study.
Pak J Med Sci. 2022;38(7):2021-26. doi:10.12669/pjms.
38.7.2021
14. Gyaase D, Enuameh YA, Adjei BN, Mensah KB, Adu-Gyamfi
R, Owusu-Agyei S, et al. Determinants of caesarean section
among women in Ghana. BMC Pregnancy Childbirth.
2023;23:286. doi:10.1186/s12884-023-05586-5
15. Muhammad T, Srivastava S, Kumar P, Singh SK, Singh A,
Parasuraman S, et al. Socioeconomic and demographic
predictors of caesarean section in Bangladesh. BMC Pregnancy
Childbirth. 2022;22:512. doi:10.1186/s12884-022-04883-7
16. Lubrano C, Locati F, Parisi F, Giannini D, Risi R, Vassallo
C, et al. Gestational weight gain and pre-pregnancy BMI in
relation to obstetric outcomes. Nutrients. 2025;17(4):736.
doi:10.3390/nu17040736
17. Ramos SZ, Lewkowitz AK, Lord MG, Friedman AM, Ananth
CV, Gyamfi-Bannerman C, et al. Predicting Caesareans
delivery in high-risk pregnancies: Clinical implications. Am
J Obstet Gynecol. 2023;229(5):549.e1-549.e8. doi:10.1016/
j.ajog.2023.06.032
18. Wang R, Liang X, Su XY. Maternal risk factors and obstetric
outcomes: A clinical review. World J Psychiatry.
2024;14(10):1448-58. doi:10.5498/wjp.v14.i10.1448
19. Nedberg IH, Lazzerini M, Mariani I, Ekerhovd E, Skalkidou
A, Essén B, et al. Maternal risk factors and trends in Caesareans
delivery: A population-based study. PLoS Med.
2021;18(11):e1003764. doi:10.1371/journal.pmed.1003764
20. Dhakal-Rai S, van Teijlingen E, Regmi P, Bhandari N,
Simkhada P, Raja EA, et al. Caesarean section trends and
determinants in South Asia: A systematic review. Asian J Med
Sci. 2022;13(3):143-74.
21. Qureshi FU, Sohail S, Jabeen S, Ahmed R, Khan MA, Ali S,
et al. Patterns and determinants of caesarean section in a
tertiary care hospital. J Rawalpindi Med Coll. 2025;29(1):2-
7.
22. Alipour A, Hantoushzadeh S, Hessami K, Shafaghi A, Ghaffari
S, Jamali S, et al. Socioeconomic inequalities and Caesarean
rates. BMC Pregnancy Childbirth. 2022;22:821. doi:10.1186/
s12884-022-05168-9
23. Islam N, Thalib L, Mahmood S, Al-Hadithi T, Al-Dabbagh
B, Hussain S, et al. Risk factors associated with surgical
outcomes in obstetrics: A meta-analysis. Intensive Crit Care
Nurs. 2025;89:103951. doi:10.1016/j.iccn.2024.103951
24. Grisbrook MA, Dewey D, Cuthbert C, Letourneau N,
McDonald S, Tough S, et al. Psychological outcomes following
Caesareans delivery. Int J Environ Res Public Health.
2022;19(9):4900. doi:10.3390/ijerph19094900
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of Bahria University Medical & Dental College is an open access journal and is licensed under CC BY-NC 4.0. which permits unrestricted non commercial use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0
