WHO global survey shows high rates of caesareans.
Cesarean section (Patient outcomes)
|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|
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 Adjusted 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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