WHO global survey shows high rates of caesareans.
Subject: Cesarean section (Statistics)
Cesarean section (Patient outcomes)
Pub Date: 05/01/2010
Publication: Name: Reproductive Health Matters Publisher: Reproductive Health Matters Audience: General Format: Magazine/Journal Subject: Family and marriage; Health; Women's issues/gender studies Copyright: COPYRIGHT 2010 Reproductive Health Matters ISSN: 0968-8080
Issue: Date: May, 2010 Source Volume: 18 Source Issue: 35
Topic: Event Code: 680 Labor Distribution by Employer
Organization: Organization: World Health Organization
Geographic: Geographic Code: 90ASI Asia
Accession Number: 236247747
Full Text: There is concern about rising rates of caesarean section worldwide. This article reports the third phase of the WHO global survey to estimate the rate of different delivery methods and their relation to maternal and perinatal outcomes in Africa and Latin America (2004-05), and in Asia (2007-08). The Asia survey included Cambodia, China, India, Japan, Nepal, Philippines, Sri Lanka, Thailand and Viet Nam. In each country, the capital city and two other regions were randomly selected. Data were collected on obstetric anal perinatal events for all women admitted for delivery to randomly selected facilities during two or three month periods. 107,950 deliveries in 122 recruited facilities were analysed. The overall caesarean section rate was 27.3% and operative vaginal delivery rate was 3.2%. China had the highest overall caesarean rate (46.2%) followed by Viet Nam, Thailand and Sri Lanka; Cambodia had the lowest (14.7%). Operative vaginal delivery and caesarean section were independently associated with increased risk of maternal mortality and morbidity index (at least one of maternal mortality, admission to intensive care, blood transfusion, hysterectomy or internal iliac artery ligation), both for those with and without a medical indication for caesarean section (see Table 1). Increased risk was mainly attributable to increased admission to intensive care and blood transfusion.

For breech presentation, caesarean section, either antepartum (OR 0.2, 95% CI 0.1-0.3) or intrapartum (OR 0.3, 95% CI 0.2-0.4), was associated with improved perinatal outcomes, but also with increased risk of stay in neonatal intensive care (OR 2.0, 95% CI 1.1-3.6 and OR 2.1,95% CI 1.2-3.7 respectively). This survey confirms findings of the previous Latin American survey and recommends that to improve maternal and perinatal outcomes and save money, caesarean sections should be carried out only when there is a medical indication. (1)

(1.) Lumbiganon P, Laopaiboon M, Gulmezoglu AM, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08. Lancet 2010;375(9713):490-99.
Table 1. Delivery method and risk of material
mortality and morbidity

                             odds ratio
                            for risk of
                         maternal mortality      95%
Delivery                   and morbidity      confidence
method                         index           interval

Spontaneous (reference)          1

Operative vaginal               2.1            1.7-2.6

Antepartum caesarean
without indications             2.7            1.4-5.5

Antepartum caesarean
with indications                10.6           9.3-12.0

Intraparturn caesarean
without indications             14.2           9.8-20.7

Intrapartum caesarean
with indications                14.5          13.2-16.0
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