Margo S Harrison1, Omrana Pasha2, Sarah Saleem2, Sumera Ali2, Elwyn Chomba3, Waldemar A Carlo4, Ana L Garces5, Nancy F Krebs6, K Michael Hambidge6, Shivaprasad S Goudar7, Bhala Kodkany7, Sangappa Dhaded7, Richard J Derman8, Archana Patel9, Patricia L Hibberd10, Fabian Esamai11, Edward A Liechty12, Janet L Moore13, Dennis Wallace13, Elizabeth M Mcclure13, Menachem Miodovnik14, Marion Koso-Thomas14, Jose Belizan15, Antoinette K Tshefu16, Melissa Bauserman17, Robert L Goldenberg1. 1. Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA. 2. Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. 3. University Teaching Hospital, University of Zambia, Lusaka, Zambia. 4. Division of Neonatology, University of Alabama, Birmingham, AL, USA. 5. Planning Unit, Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala. 6. School of Medicine, University of Colorado, Denver, CO, USA. 7. Jawaharlal Nehru Medical College, KLE University, Belgaum, India. 8. Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA. 9. Lata Medical Research Foundation, Nagpur, India. 10. School of Public Health, Boston University, Boston, MA, USA. 11. School of Medicine, Moi University, Eldoret, Kenya. 12. School of Medicine, Indiana University, Indianapolis, IN, USA. 13. RTI International, Durham, NC, USA. 14. Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA. 15. Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina. 16. Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo. 17. Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Abstract
INTRODUCTION: Cesarean section (CS) rates are increasing globally with an unclear effect on pregnancy outcomes. The study objective was to quantify maternal and perinatal morbidity and mortality associated with CS compared with vaginal delivery (VD) both within and across sites in low- and middle-income countries. MATERIAL AND METHODS: A prospective population-based study including home and facility births in 337 153 women with a VD and 47 308 women with a CS from 2010 to 2015 was performed in Guatemala, India, Kenya, Pakistan, Zambia and Democratic Republic of Congo. Women were enrolled during pregnancy; delivery and 6-week follow-up data were collected. RESULTS: Across all sites, CS rates increased from 8.6% to 15.2%, but remained low in African sites. Younger, nulliparous women were more likely to have a CS, as were women with higher education and those delivering an infant weighing 1500-2499 g. Across all sites, maternal and neonatal mortality was higher, and stillbirths were lower, in pregnancies delivered by CS. Antepartum and postpartum complications as well as obstetric interventions and treatments were more common among women who underwent CS. In stratified analyses, all outcomes were worse in women with a CS compared with VD in African compared to non-African sites. CONCLUSIONS: CS rates increased across all sites during the study period, but at more pronounced rates in the non-African sites. CS was associated with reduced postpartum hemorrhage and lower rates of stillbirths in the non-African sites. In the African sites, CS was associated with an increase in all adverse outcomes. Further studies are necessary to better understand the increase in adverse outcomes with CS in the African sites.
INTRODUCTION: Cesarean section (CS) rates are increasing globally with an unclear effect on pregnancy outcomes. The study objective was to quantify maternal and perinatal morbidity and mortality associated with CS compared with vaginal delivery (VD) both within and across sites in low- and middle-income countries. MATERIAL AND METHODS: A prospective population-based study including home and facility births in 337 153 women with a VD and 47 308 women with a CS from 2010 to 2015 was performed in Guatemala, India, Kenya, Pakistan, Zambia and Democratic Republic of Congo. Women were enrolled during pregnancy; delivery and 6-week follow-up data were collected. RESULTS: Across all sites, CS rates increased from 8.6% to 15.2%, but remained low in African sites. Younger, nulliparous women were more likely to have a CS, as were women with higher education and those delivering an infant weighing 1500-2499 g. Across all sites, maternal and neonatal mortality was higher, and stillbirths were lower, in pregnancies delivered by CS. Antepartum and postpartum complications as well as obstetric interventions and treatments were more common among women who underwent CS. In stratified analyses, all outcomes were worse in women with a CS compared with VD in African compared to non-African sites. CONCLUSIONS: CS rates increased across all sites during the study period, but at more pronounced rates in the non-African sites. CS was associated with reduced postpartum hemorrhage and lower rates of stillbirths in the non-African sites. In the African sites, CS was associated with an increase in all adverse outcomes. Further studies are necessary to better understand the increase in adverse outcomes with CS in the African sites.
Authors: Meghan A Bohren; Erin C Hunter; Heather M Munthe-Kaas; João Paulo Souza; Joshua P Vogel; A Metin Gülmezoglu Journal: Reprod Health Date: 2014-09-19 Impact factor: 3.223
Authors: Ana Pilar Betrán; Jianfeng Ye; Anne-Beth Moller; Jun Zhang; A Metin Gülmezoglu; Maria Regina Torloni Journal: PLoS One Date: 2016-02-05 Impact factor: 3.240
Authors: Cassandra R Duffy; Janet L Moore; Sarah Saleem; Antoinette Tshefu; Carl L Bose; Elwyn Chomba; Waldemar A Carlo; Ana L Garces; Nancy F Krebs; K Michael Hambidge; Shivaprasad S Goudar; Richard J Derman; Archana Patel; Patricia L Hibberd; Fabian Esamai; Edward A Liechty; Dennis D Wallace; Elizabeth M McClure; Robert L Goldenberg Journal: Acta Obstet Gynecol Scand Date: 2018-12-20 Impact factor: 3.636
Authors: Margo S Harrison; Ephrem Kirub; Tewodros Liyew; Biruk Teshome; Andrea Jimenez-Zambrano; Margaret Muldrow; Teklemariam Yarinbab Journal: J Womens Health Dev Date: 2021-04-14