Caesarean Section without Medical Indications is Associated with an Increased Risk of Adverse Short-term Maternal Outcomes : The 2004-2008 WHO Global Survey on Maternal and Perinatal Health
BACKGROUND: There is worldwide debate about the appropriateness of caesarean sections performed without medical indications. In this analysis, we aim to further investigate the relationship between caesarean section without medical indication and severe maternal outcomes. METHODS: This is a multicou...
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| Format: | Journal Article |
| Language: | EN |
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2012
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| Online Access: | http://hdl.handle.net/10986/5137 |
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okr-10986-51372021-04-23T14:02:21Z Caesarean Section without Medical Indications is Associated with an Increased Risk of Adverse Short-term Maternal Outcomes : The 2004-2008 WHO Global Survey on Maternal and Perinatal Health Souza, J. P. Gulmezoglu, A. Lumbiganon, P. Laopaiboon, M. Carroli, G. Fawole, B. Ruyan, P. Adolescent Adult Africa Asia Cesarean Section Female Humans Intensive Care Latin America Mortality Pregnancy Risk Factors World Health Organization Young Adult BACKGROUND: There is worldwide debate about the appropriateness of caesarean sections performed without medical indications. In this analysis, we aim to further investigate the relationship between caesarean section without medical indication and severe maternal outcomes. METHODS: This is a multicountry, facility-based survey that used a stratified multistage cluster sampling design to obtain a sample of countries and health institutions worldwide. A total of 24 countries and 373 health facilities participated in this study. Data collection took place during 2004 and 2005 in Africa and the Americas and during 2007 and 2008 in Asia. All women giving birth at the facility during the study period were included and had their medical records reviewed before discharge from the hospital. Univariate and multilevel analysis were performed to study the association between each group's mode of delivery and the severe maternal and perinatal outcome. RESULTS: A total of 286,565 deliveries were analysed. The overall caesarean section rate was 25.7% and a total of 1.0 percent of all deliveries were caesarean sections without medical indications, either due to maternal request or in the absence of other recorded indications. Compared to spontaneous vaginal delivery, all other modes of delivery presented an association with the increased risk of death, admission to ICU, blood transfusion and hysterectomy, including antepartum caesarean section without medical indications (Adjusted Odds Ratio (Adj OR), 5.93, 95% Confidence Interval (95% CI), 3.88 to 9.05) and intrapartum caesarean section without medical indications (Adj OR, 14.29, 95% CI, 10.91 to 18.72). In addition, this association is stronger in Africa, compared to Asia and Latin America. CONCLUSIONS: Caesarean sections were associated with an intrinsic risk of increased severe maternal outcomes. We conclude that caesarean sections should be performed when a clear benefit is anticipated, a benefit that might compensate for the higher costs and additional risks associated with this operation. 2012-03-30T07:31:29Z 2012-03-30T07:31:29Z 2010 Journal Article BMC Med 1741-7015 (Electronic) 1741-7015 (Linking) http://hdl.handle.net/10986/5137 EN http://creativecommons.org/licenses/by-nc-nd/3.0/igo World Bank Journal Article |
| repository_type |
Digital Repository |
| institution_category |
Foreign Institution |
| institution |
Digital Repositories |
| building |
World Bank Open Knowledge Repository |
| collection |
World Bank |
| language |
EN |
| topic |
Adolescent Adult Africa Asia Cesarean Section Female Humans Intensive Care Latin America Mortality Pregnancy Risk Factors World Health Organization Young Adult |
| spellingShingle |
Adolescent Adult Africa Asia Cesarean Section Female Humans Intensive Care Latin America Mortality Pregnancy Risk Factors World Health Organization Young Adult Souza, J. P. Gulmezoglu, A. Lumbiganon, P. Laopaiboon, M. Carroli, G. Fawole, B. Ruyan, P. Caesarean Section without Medical Indications is Associated with an Increased Risk of Adverse Short-term Maternal Outcomes : The 2004-2008 WHO Global Survey on Maternal and Perinatal Health |
| relation |
http://creativecommons.org/licenses/by-nc-nd/3.0/igo |
| description |
BACKGROUND: There is worldwide debate about the appropriateness of caesarean sections performed without medical indications. In this analysis, we aim to further investigate the relationship between caesarean section without medical indication and severe maternal outcomes. METHODS: This is a multicountry, facility-based survey that used a stratified multistage cluster sampling design to obtain a sample of countries and health institutions worldwide. A total of 24 countries and 373 health facilities participated in this study. Data collection took place during 2004 and 2005 in Africa and the Americas and during 2007 and 2008 in Asia. All women giving birth at the facility during the study period were included and had their medical records reviewed before discharge from the hospital. Univariate and multilevel analysis were performed to study the association between each group's mode of delivery and the severe maternal and perinatal outcome. RESULTS: A total of 286,565 deliveries were analysed. The overall caesarean section rate was 25.7% and a total of 1.0 percent of all deliveries were caesarean sections without medical indications, either due to maternal request or in the absence of other recorded indications. Compared to spontaneous vaginal delivery, all other modes of delivery presented an association with the increased risk of death, admission to ICU, blood transfusion and hysterectomy, including antepartum caesarean section without medical indications (Adjusted Odds Ratio (Adj OR), 5.93, 95% Confidence Interval (95% CI), 3.88 to 9.05) and intrapartum caesarean section without medical indications (Adj OR, 14.29, 95% CI, 10.91 to 18.72). In addition, this association is stronger in Africa, compared to Asia and Latin America. CONCLUSIONS: Caesarean sections were associated with an intrinsic risk of increased severe maternal outcomes. We conclude that caesarean sections should be performed when a clear benefit is anticipated, a benefit that might compensate for the higher costs and additional risks associated with this operation. |
| format |
Journal Article |
| author |
Souza, J. P. Gulmezoglu, A. Lumbiganon, P. Laopaiboon, M. Carroli, G. Fawole, B. Ruyan, P. |
| author_facet |
Souza, J. P. Gulmezoglu, A. Lumbiganon, P. Laopaiboon, M. Carroli, G. Fawole, B. Ruyan, P. |
| author_sort |
Souza, J. P. |
| title |
Caesarean Section without Medical Indications is Associated with an Increased Risk of Adverse Short-term Maternal Outcomes : The 2004-2008 WHO Global Survey on Maternal and Perinatal Health |
| title_short |
Caesarean Section without Medical Indications is Associated with an Increased Risk of Adverse Short-term Maternal Outcomes : The 2004-2008 WHO Global Survey on Maternal and Perinatal Health |
| title_full |
Caesarean Section without Medical Indications is Associated with an Increased Risk of Adverse Short-term Maternal Outcomes : The 2004-2008 WHO Global Survey on Maternal and Perinatal Health |
| title_fullStr |
Caesarean Section without Medical Indications is Associated with an Increased Risk of Adverse Short-term Maternal Outcomes : The 2004-2008 WHO Global Survey on Maternal and Perinatal Health |
| title_full_unstemmed |
Caesarean Section without Medical Indications is Associated with an Increased Risk of Adverse Short-term Maternal Outcomes : The 2004-2008 WHO Global Survey on Maternal and Perinatal Health |
| title_sort |
caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes : the 2004-2008 who global survey on maternal and perinatal health |
| publishDate |
2012 |
| url |
http://hdl.handle.net/10986/5137 |
| _version_ |
1764394082828812288 |