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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
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
BMC Medicine, Volume 8, Article 71, Year 2010
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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. © 2010 Souza et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Souza, Joao Paulo
United States, Washington, D.c.
The World Bank, Usa
Gülmezoglu, Ahmet Metin
United States, Washington, D.c.
The World Bank, Usa
Lumbiganon, Pisake
Thailand, Khon Kaen
Faculty of Medicine, Khon Kaen University
Laopaiboon, Malinee
Thailand, Khon Kaen
Khon Kaen University
Carroli, Guillermo
Argentina, Rosario
Centro Rosarino de Estudios Perinatales
Fawole, Bukola O.
Nigeria, Ibadan
University College Hospital, Ibadan
Pang, Ruyan
China, Beijing
Peking University Health Science Center
Statistics
Citations: 665
Authors: 7
Affiliations: 6
Identifiers
Doi:
10.1186/1741-7015-8-71
e-ISSN:
17417015
Research Areas
Health System And Policy
Maternal And Child Health
Study Design
Cross Sectional Study
Case-Control Study
Grounded Theory
Study Approach
Quantitative
Participants Gender
Female