Obstetric complications and cesarean delivery in Nepal.
OBJECTIVE
To determine the incidence of obstetric complications, the stillbirth rate, and the factors associated with cesarean delivery in central Nepal.


METHODS
A community-based prospective cohort study was undertaken in the Kaski district during 2011-2012. In total, 701 women who were at least 5 months pregnant were recruited and interviewed. Participants were followed-up and interviewed again within 45 days after delivery.


RESULTS
Of the 658 women who remained in the cohort after 43 were lost to follow-up, 12 (1.8%) had stillbirths. Cesareans accounted for 13.3% of the total deliveries. Age, urban residency, college-level education, and particularly presence of intrapartum symptoms significantly increased the likelihood of cesarean delivery. Prepartum, intrapartum, and postpartum symptoms were reported by 21.1%, 24.4%, and 10.2% of women, respectively. Common danger signs included prolonged labor, severe abdominal pain, swollen hand and body, and heavy bleeding.


CONCLUSIONS
Obstetric complications and stillbirth rates were relatively high in central Nepal. Cesarean delivery appeared to meet obstetric need and was performed with medical indication, particularly after the onset of labor.
School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal; School of Public Health, Curtin University, Perth, Australia.
Rajendra
R
Karkee
School of Public Health, Curtin University, Perth, Australia. Electronic address: andy.lee@curtin.edu.au.
Andy H
AH
Lee
Sanjeevani College of Medical Sciences, Butwal, Nepal.
Vishnu
V
Khanal
School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal.
Paras K
PK
Pokharel
School of Public Health, Curtin University, Perth, Australia.
Colin W
CW
Binns
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007743:Labor, Obstetric; D009390:Nepal / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology*; D055815:Young Adult
Cesarean delivery; Nepal; Obstetric complications; Pregnancy outcomes; Stillbirth