{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:01:26Z","timestamp":1792033286513,"version":"4.4.0"},"reference-count":36,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,13]],"date-time":"2023-01-13T00:00:00Z","timestamp":1673568000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Research Deanship, University of Ha\u2019il","award":["RG-21068"],"award-info":[{"award-number":["RG-21068"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>In the context of the global increase in the rate of cesarean deliveries, with an associated higher morbidity and mortality, this study aimed to investigate the role of maternal age and parity in the cesarean section rate among women in the Hail Region of Saudi Arabia. This retrospective cohort study used data collected from the labor ward of the Maternity and Child Health Hospital, Hail, over a period of 8 months, forming a cohort of 500 women. Women were categorized into four different parity classes. The results revealed that there was no significant relationship between cesarean deliveries and maternal age (p-value, 0.07). There was no significant difference in the mode of delivery between the study\u2019s parity cohort group. A significant increase in cesarean deliveries was noticed among obese women with a BMI between 35\u201339.9 (52.14%). This increase was even greater among those with a BMI above 40 (63.83%). Fetal distress, malpresentation and abruptio placenta were the most significant indications for CS among all age groups (p-value 0.000, 0.021, and 0.048, respectively). Conclusions: The number of cesarean deliveries has no association with parity or age. However, there was a statistically significant association with BMI, a perineal tear after previous vaginal delivery, and a history of diabetes mellitus and gestational diabetes. The most reported reasons for CS were fetal distress, malpresentation, and abruptio placenta among all age groups.<\/jats:p>","DOI":"10.3390\/ijerph20021486","type":"journal-article","created":{"date-parts":[[2023,1,13]],"date-time":"2023-01-13T05:09:32Z","timestamp":1673586572000},"page":"1486","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Role of Parity and Age in Cesarean Section Rate among Women: A Retrospective Cohort Study in Hail, Saudi Arabia"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5861-9960","authenticated-orcid":false,"given":"Reem Falah","family":"Alshammari","sequence":"first","affiliation":[{"name":"Department of Family and Community Medicine, College of Medicine, University of Ha\u2019il, Ha\u2019il 55476, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farida Habib","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, College of Medicine, University of Ha\u2019il, Ha\u2019il 55476, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6396-9263","authenticated-orcid":false,"given":"Hend Mohammed","family":"Alkwai","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, College of Medicine, University of Ha\u2019il, Ha\u2019il 55476, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahaad","family":"Alenazi","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, College of Medicine, University of Ha\u2019il, Ha\u2019il 55476, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid Farhan","family":"Alshammari","sequence":"additional","affiliation":[{"name":"Department of Medicine, College of Medicine, University of Ha\u2019il, Ha\u2019il 55476, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ehab Kamal Ahmed","family":"Sogeir","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, College of Medicine, University of Ha\u2019il, Ha\u2019il 55476, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asma","family":"Batool","sequence":"additional","affiliation":[{"name":"Maternity and Child Hospital, Ha\u2019il 55471, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayesha Akbar","family":"Khalid","sequence":"additional","affiliation":[{"name":"William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust Kent, Canterbury CT1 3NG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1515\/jpm-2020-0305","article-title":"Cesarean section one hundred years 1920\u20132020: The Good, the Bad and the Ugly","volume":"49","author":"Antoine","year":"2021","journal-title":"J. Perinat. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e005671","DOI":"10.1136\/bmjgh-2021-005671","article-title":"Trends and projections of caesarean section rates: Global and regional estimates","volume":"6","author":"Betran","year":"2021","journal-title":"BMJ Glob. Health"},{"key":"ref_3","first-page":"301","article-title":"Why do some pregnant women prefer caesarean delivery in first pregnancy?","volume":"11","author":"Ali","year":"2013","journal-title":"Iran. J. Reprod. Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Torloni, M.R., Betran, A.P., Montilla, P., Scolaro, E., Seuc, A., Mazzoni, A., Althabe, F., Merzagora, F., Donzelli, G.P., and Merialdi, M. (2013). Do Italian women prefer cesarean section? Results from a survey on mode of delivery preferences. BMC Pregnancy Childbirth, 13.","DOI":"10.1186\/1471-2393-13-78"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.ijgo.2011.07.011","article-title":"A national review of cesarean delivery in Ethiopia","volume":"115","author":"Fesseha","year":"2011","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/1742-4755-11-14","article-title":"Trend and socio-demographic differentials of cesarean section rate in Addis Ababa, Ethiopia: Analysis based on Ethiopia demographic and health surveys data","volume":"11","author":"Gebremedhin","year":"2014","journal-title":"Reprod. Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1080\/07399332.2012.721416","article-title":"E boom in unnecessary caesarean surgeries is jeopardizing women\u2019s health","volume":"34","author":"Ajeet","year":"2013","journal-title":"Health Care Women Int."},{"key":"ref_8","first-page":"1","article-title":"Determinants of Caesarean Section Rates in Developed Countries: Supply, Demand and Opportunities for Control","volume":"29","author":"Lauer","year":"2010","journal-title":"World Health Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1523-536X.2007.00205.x","article-title":"Neonatal mortality for primary cesarean and vaginal births to low-risk women: Application of an \u201cintention-to-treat\u201d model","volume":"35","author":"MacDorman","year":"2008","journal-title":"Birth"},{"key":"ref_10","unstructured":"Nassar, N., and Sullivan, E.A. (2001). Australia\u2019s mothers and babies 1999. Perinatal Statistics Series, AIHW National Perinatal Statistics Unit."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1080\/01443610802091768","article-title":"A pilot study exploring the impact of maternal age and raised body mass index on caesarean section rates","volume":"28","author":"Naftalin","year":"2008","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3038","DOI":"10.4314\/ahs.v19i4.25","article-title":"Impact of parity and gestational age of mothers with hypertension on birth weight, red blood cells and mode of delivery of their babies","volume":"19","author":"Okoye","year":"2019","journal-title":"Afr. Health Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1046\/j.1341-8076.2002.00008.x","article-title":"Cesarean section rate: The effect of age and parity","volume":"28","author":"Qublan","year":"2002","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/S0301-2115(01)00498-5","article-title":"Extreme grandmultiparity: Is it an obstetric risk factor?","volume":"101","author":"Kumari","year":"2002","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_15","first-page":"1","article-title":"From MDGs to SDGs: What are the sustainable development goals","volume":"1","author":"Woodbridge","year":"2015","journal-title":"Bonn ICLEI\u2014Local Gov. Sustain."},{"key":"ref_16","unstructured":"World Health Organization (2014). Maternal Mortality: Fact Sheet: To Improve Maternal Health, Barriers that Limit Access to Quality Maternal Health Services Must Be Identified and Addressed at All Levels of the Health System, No. WHO\/RHR\/14.06."},{"key":"ref_17","first-page":"100078","article-title":"The Mode of delivery of grand multiparous with post-cesarean single uterine scar in low resources settings: A retrospective cohort study","volume":"4","author":"Etienne","year":"2019","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Al-Rifai, R.H., Elbarazi, I., Ali, N., Loney, T., Oulhaj, A., and Ahmed, L.A. (2021). Knowledge and preference towards mode of delivery among pregnant women in the United Arab Emirates: The Mutaba\u2019ah study. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18010036"},{"key":"ref_19","first-page":"e180010","article-title":"Early and late puerperal complications associated with the mode of delivery in a cohort in Brazil","volume":"21","author":"Mascarello","year":"2018","journal-title":"Rev. Bras. Epidemiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"535","DOI":"10.31729\/jnma.3467","article-title":"Cesarean vs. Vaginal Delivery: An Institutional Experience","volume":"56","author":"Sharma","year":"2018","journal-title":"J. Nepal Med. Assoc."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Zar\u0119ba, K., Banasiewicz, J., Rozenek, H., W\u00f3jtowicz, S., and Jakiel, G. (2020). Peripartum predictors of the risk of postpartum depressive disorder: Results of a case-control study. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17238726"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1111\/j.1523-536X.1992.tb00367.x","article-title":"US cesarean section rates","volume":"19","author":"Taffel","year":"1992","journal-title":"Birth"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"129","DOI":"10.3109\/00016349409013415","article-title":"Indications for cesarean section in singleton pregnancies in two Danish countries with different cesarean section rates","volume":"73","author":"Sperling","year":"1994","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.15537\/smj.2018.11.22499","article-title":"Cesarean sections. Associated factors and frequency at King Abdulaziz Medical City in the Central Region of the Kingdom of Saudi Arabia","volume":"39","author":"Ahmed","year":"2018","journal-title":"Saudi Med. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"179","DOI":"10.5144\/0256-4947.51773","article-title":"Cesarean delivery rates in Saudi Arabia: A ten-year review","volume":"29","year":"2009","journal-title":"Ann. Saudi Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Al Rowaily, M.A., Alsalem, F.A., and Abolfotouh, M.A. (2014). Cesarean section in a high-parity community in Saudi Arabia: Clinical indications and obstetric outcomes. BMC Pregnancy Childbirth, 28.","DOI":"10.1186\/1471-2393-14-92"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.3889\/oamjms.2019.587","article-title":"Evaluation of Pregnancy Outcomes at Advanced Maternal Age","volume":"7","author":"Adrianowicz","year":"2019","journal-title":"Open Access Maced. J. Med. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1080\/14767058.2016.1211633","article-title":"Is primiparity a risk factor for advanced maternal age pregnancies?","volume":"30","author":"Kalayci","year":"2017","journal-title":"J. Matern. Fetal. Neonatal. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1378","DOI":"10.1089\/jwh.2018.7027","article-title":"Outcomes of Women Delivering at Very Advanced Maternal Age","volume":"27","author":"Arya","year":"2018","journal-title":"J. Women\u2019s Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1590\/1806-93042021000100004","article-title":"The role of parity in the mode of delivery in advanced maternal age women","volume":"21","author":"Martinelli","year":"2021","journal-title":"Revista Brasileira de Sa\u00fade Materno Infantil"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Deng, R., Tang, X., Liu, J., Gao, Y., and Zhong, X. (2021). Cesarean delivery on maternal request and its influencing factors in Chongqing, China. BMC Pregnancy Childbirth, 19.","DOI":"10.1186\/s12884-021-03866-7"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1111\/j.1471-0528.2006.01038.x","article-title":"Linear association between maternal prepregnancy body mass index and risk of caesarean section in term deliveries","volume":"113","author":"Barau","year":"2006","journal-title":"BJOG"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1067\/mob.2002.126200","article-title":"Factors that are associated with cesarean delivery in a large private practice: The importance of pre-pregnancy body mass index and weight gain","volume":"187","author":"Young","year":"2002","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/AOG.0b013e3182952242","article-title":"Primary Cesarean Delivery in the United States","volume":"122","author":"Boyle","year":"2013","journal-title":"Obstet. Gynecol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"585","DOI":"10.5144\/0256-4947.1995.585","article-title":"Primary cesarean section in King Khalid University Hospital: Indications and obstetric outcome","volume":"15","author":"Khashoggi","year":"1995","journal-title":"Ann. Saudi Med."},{"key":"ref_36","first-page":"e29400","article-title":"Disparities in Incidences of Cesarean Section Among Women with Gestational Diabetes Mellitus in the United States","volume":"14","author":"Akinyemi","year":"2022","journal-title":"Cureus"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/2\/1486\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:05:19Z","timestamp":1760119519000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/2\/1486"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,13]]},"references-count":36,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["ijerph20021486"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20021486","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,13]]}}}