T Begum1,2,3, K M Saif-Ur-Rahman3,4, F Yaqoot1,5, J Stekelenburg6,7, S Anuradha8, T Biswas1,2, S A Doi9, A A Mamun1,2. 1. Institute for Social Science Research, The University of Queensland, Indooroopilly, Queensland, Australia. 2. Australian Research Council (ARC), Centre of Excellence for Children and Families over the Life Course Centre, The University of Queensland, Indooroopilly, Queensland, Australia. 3. Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh. 4. Graduate School of Medicine, Nagoya University, Nagoya, Japan. 5. Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia. 6. Department of Health Sciences, Global Health Unit, University Medical Center Groningen, Groningen, the Netherlands. 7. Department Obstetrics & Gynaecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands. 8. School of Public Health, The University of Queensland, Indooroopilly, Queensland, Australia. 9. Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar.
Abstract
BACKGROUND: Caesarean delivery on maternal request (CDMR) is considered a significant contributor to the unprecedented increase in caesarean deliveries (CDs) for nonclinical reasons. Current literature lacks a reliable assessment of the rate of CDMR, which hinders the planning and delivery of appropriate interventions for reducing CDMR rates. OBJECTIVES: To conduct a systematic review of the literature and meta-regression to explore the global incidence of CDMR. SEARCH STRATEGY: PubMed, Embase, CINAHL, Medline, Google scholar and grey literature were searched from January 1985 to May 2019. SELECTION CRITERIA: Observational studies that report CDMR data were included. We excluded non-English articles, case notes, editorial reviews and articles reporting elective CDs from pregnancy risk factors. DATA COLLECTION AND ANALYSIS: Two reviewers independently conducted the screening and quality appraisal using a validated tool. The weighted average of CDMR over total deliveries (absolute proportion) and by total CDs (relative proportion) were generated. Quality-effects meta-regression was used to explain the variability of the CDMR estimates by moderators, including study methodology and demography of study participants. MAIN RESULTS: We identified 31 articles from 14 countries that include 5 million total births. The absolute proportion of CDMR varies between 0.2 and 42.0%, with significant variations across studies and subgroups. The economic status of the country and study year together explained 84% of the absolute and 76% of the relative proportion of CDMR variation. CONCLUSIONS: An appropriate reporting of CDMR should be a key priority in maternal health policies and practices. TWEETABLE ABSTRACT: Globally, the proportion of maternal requested caesarean delivery has mostly been influenced by the economic status of the country.
BACKGROUND: Caesarean delivery on maternal request (CDMR) is considered a significant contributor to the unprecedented increase in caesarean deliveries (CDs) for nonclinical reasons. Current literature lacks a reliable assessment of the rate of CDMR, which hinders the planning and delivery of appropriate interventions for reducing CDMR rates. OBJECTIVES: To conduct a systematic review of the literature and meta-regression to explore the global incidence of CDMR. SEARCH STRATEGY: PubMed, Embase, CINAHL, Medline, Google scholar and grey literature were searched from January 1985 to May 2019. SELECTION CRITERIA: Observational studies that report CDMR data were included. We excluded non-English articles, case notes, editorial reviews and articles reporting elective CDs from pregnancy risk factors. DATA COLLECTION AND ANALYSIS: Two reviewers independently conducted the screening and quality appraisal using a validated tool. The weighted average of CDMR over total deliveries (absolute proportion) and by total CDs (relative proportion) were generated. Quality-effects meta-regression was used to explain the variability of the CDMR estimates by moderators, including study methodology and demography of study participants. MAIN RESULTS: We identified 31 articles from 14 countries that include 5 million total births. The absolute proportion of CDMR varies between 0.2 and 42.0%, with significant variations across studies and subgroups. The economic status of the country and study year together explained 84% of the absolute and 76% of the relative proportion of CDMR variation. CONCLUSIONS: An appropriate reporting of CDMR should be a key priority in maternal health policies and practices. TWEETABLE ABSTRACT: Globally, the proportion of maternal requested caesarean delivery has mostly been influenced by the economic status of the country.
Authors: Y Zhang; A P Betran; X Li; D Liu; N Yuan; L Shang; W Lin; S Tu; L Wang; X Wu; T Zhu; Y Zhang; Z Lu; L Zheng; C Gu; J Fang; Z Liu; L Ma; Z Cai; X Yang; H Li; H Zhang; X Zhao; L Yan; L Wang; X Sun; Q Luo; L Liu; J Zhu; W Qin; Q Yao; S Dong; Y Yang; Z Cui; Y He; X Feng; L He; H Zhang; L Zhang; X Wang; J P Souza; H Qi; T Duan; J Zhang Journal: BJOG Date: 2021-10-26 Impact factor: 7.331