TITLE:
A Systematic Review of Maternal and Neonatal Outcomes Following Caesarean and Vaginal Delivery in Primigravida among Low- & Middle-Income Countries
AUTHORS:
Ayalur Gopalkrishnan Radhika, Nishad Plakkal, Usha Devi, Amita Suneja, Sreekumaran Nair, Vasumati Sriganesh, Anish Keepanaseril, Kushagra Shiromani
KEYWORDS:
Primigravida, Cesarean Section, Vaginal Delivery, Route of Delivery, Low-Middle Income Country, Systematic Review, Secondary Research
JOURNAL NAME:
Open Journal of Epidemiology,
Vol.15 No.4,
November
5,
2025
ABSTRACT: Introduction: Cesarean section (CS) rates have been rising globally, particularly in LMICs, often exceeding WHO recommendations. This systematic review evaluates maternal and neonatal outcomes of CS versus vaginal delivery (VD) among primigravida in LMICs and highlights implications for balanced policy and practice. Methods: We searched PUBMED, EMBASE, SCOPUS, LENS, GIM, BASE, and Google Scholar for studies published in English between 2000-2024, following PRISMA 2020 and SWiM (Synthesis Without Meta-analysis) guidelines. Eligible studies included observational study designs. Seven studies involving 110,062 primigravid women were included. Data was extracted independently by two reviewers, with quality assessment via ROBINS-I and GRADE framework. A narrative synthesis was conducted due to study heterogeneity, presenting outcomes as frequencies and percentages, with findings synthesized narratively for each outcome across the included studies, and no pooled estimates were calculated. Results: Wide variability in episiotomy (20.8% - 96%); 15.5% and 4% reported 1st & 2nd degree perineal tears in vaginal deliveries. Severe PPH was higher in CS (5.11%) than VD (2.38%) with longer hospital stay (1.83 ± 0.91 vs 1.43 ± 0.69 days; p 0.3). Neonatal mortality was 3.3% CS and 4% VD; Apgar scores were marginally higher in CS at 1 min (8.95 ± 0.22 vs 8.57 ± 1.13) and 5 min (9.97 ± 0.17 vs 9.68 ± 0.95; p Conclusion: While CS reduces long-term incontinence, it carries higher short- and long-term maternal risks. Neonatal outcomes were similar across delivery modes. These findings support judicious CS use and informed decision-making among primigravidas in LMICs.