Lanka - - > Views of Specialists on referral communications - a qualitative study from Sri Lanka

Background: Delivery by cesarean is a common operative procedure experienced by reproductive age women. Factors which increase risk include older maternal age, obesity, parity and poor vitamin D use along with a more recently defined factor maternal nutrition. Recent research has found low circulating 25-hydroxyvitamin D (25(OH)D), the primary indicator of vitamin D status, among women who were either pregnant or in their reproductive years. One way by which poor maternal vitamin D status might increase risk of cesarean delivery is by reducing strength of the pelvic musculature and the mother’s ability to push and deliver vaginally. The extent to which maternal vitamin D influences the course and outcome of human pregnancy needs to be more completely studied. Objective: To assess the possible correlation between vitamin D level and primary cesarean section. Study design: A prospective case-control study. Subjects and method: This study was carried out at AL Yarmouk Teaching Hospital, Department of Obstetrics and Gynecology for a period of 1 year from the first of October 2012 to the first of October 2013 and included 100 singleton pregnant women; fifty women with cesarean section for the first time (study group) and another fifty women with spontaneous vaginal delivery (control group). Serum level of 25(OH) vitamin D was measured in both groups and the correlation of vitamin D level with cesarean section was studied. Vitamin D level was measured; women in both groups were classified according to their vitamin D status into vitamin D deficient group (level<30nmol/L), vitamin D insufficient group (level 30-49.9 nmol/L) and those with normal (adequate) vitamin D (level>50). Results: We found that 31 women from the total number of women with cesarean section and control groups had serum 25(OH)D less than 30 nmol/L (considered as a group of vitamin D deficiency according to the Institute of Medicine (IOM)), 46% (n=23) of them delivered by cesarean section and 8% delivered vaginally; 42% women with vitamin D level between 30-49.9 nmol/L (group of vitamin D insufficiency), 32%(n=16) of them delivered by cesarean section and 26% delivered vaginally; 27% women with vitamin D =>50nmol/L (vitamin D adequacy), 22% (n=11) of them delivered by cesarean section and 16 delivered vaginally, P value 0.0001. In multivariable logistic regression analysis controlling for age, education level, BMI and vitamin D use, women with 25(OH)D less than 30 nmol/liter (group with vitamin D deficiency) were almost four and a half times as likely to have a cesarean (OR ratio=4.47, 95%CI=1.75-11.43). There was an inverse association with having a cesarean section and serum 25(OH)D levels. Conclusion: Vitamin D deficiency was associated with increased odds of primary cesarean section.