Obstetric interventions and perinatal mortality in Saudi Arabia: A quantitative analysis of regional rates and trends

Objectives. The study was designed to investigate trends and regional variations in the rates of obstetric interventions and birth-outcomes in Saudi Arabia. Methods. The population for this study was total deliveries at the Ministry of Health facilities (1983–95). The unit of analysis was each of the 5 major geographical areas in the country. Regression analysis was applied in modeling national and regional rate-trends for each type of operative deliveries as well as the incidence of perinatal mortality. Log-linear models were employed using weighted-least-squares approach to analyze changes in rates. Multiple pairwise comparison of regional fitted rates were performed. Findings. Operative vaginal deliveries (forceps, vacuum extraction, and vaginal breech) rates declined annually at 2.7% for the country (1983–95). The yearly % decreases in regional rates ranged between 4.39% (Southern) and 1.41% (Central). Only one significant difference between regional estimated rates was revealed in 1983 (Northern > Western, p < 0.001). In 1995, more statistically significant disparities in regional rates were detected. The Western region had a significant lower rate-estimate than the ones pertaining to all the other regions except that for the Southern area. Further, the Southern region had lower rate-estimate than either the Northern or Central regional estimated rates (p < 0.001 for both comparisons). Cesarean deliveries rates increased annually at 3.63% for the country (1983–95). The yearly % increases in regional rates ranged between 4.68% (Eastern) and 2.75% (Southern). In 1983, the Eastern area had a significant lower rate-estimate than either the Western or Southern regional estimated rates (p < 0.001 for both comparisons). In 1995, only one significant difference was detected (Western > Central, p = 0.003). Perinatal mortality rate declined annually at 5.24% for the country (1983–92). The % decrease/year for the major geographical area ranged between 3.09% (Western) and 8.59% (Southern). In 1983, the Western area had a significantly higher rate-estimate than either the Eastern or the Central regional estimated rates (p < 0.001 for both comparisons). Also, the Southern region had a significantly higher rate-estimate than each rate estimated for the Eastern (p < 0.001), Central (p < 0.001), and Northern (p = 0.003) regions. In 1992, the rate-estimate of the Western area was significantly higher than each rate estimated for the other four areas (p < 0.001 for all comparisons). Conclusions . The Western region appeared most notably to have unfavorable birth-outcomes that might potentially be of public health concern. Specifically, the rate-levels and trends in Makkah, Jeddah, and Ta'if need further detailed analyses. Overall, no statistically significant (p > 0.05) association was found between the categories of operative delivery, taken separately or jointly, and any of the mortality rates—stillbirth, neonatal, or perinatal. However, a negative association (r = −0.4943, p < 0.001) was found between operative vaginal and abdominal delivery regional rates (1983–95).