Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data

Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data

Author Ye, J. Google Scholar
Zhang, J. Google Scholar
Mikolajczyk, R. Google Scholar
Torloni, Maria Regina Autor UNIFESP Google Scholar
Guelmezoglu, A. M. Google Scholar
Betran, A. P. Google Scholar
Abstract ObjectiveCaesarean section was initially performed to save the lives of the mother and/or her baby. Caesarean section rates have risen substantially worldwide over the past decades. In this study, we set out to compile all available caesarean section rates worldwide at the country level, and to identify the appropriate caesarean section rate at the population level associated with the minimal maternal and neonatal mortality. DesignEcological study using longitudinal data. SettingWorldwide country-level data. PopulationA total of 159 countries were included in the analyses, representing 98.0% of global live births (2005). MethodsNationally representative caesarean section rates from 2000 to 2012 were compiled. We assessed the relationship between caesarean section rates and mortality outcomes, adjusting for socio-economic development by means of human development index (HDI) using fractional polynomial regression models. Main outcome measuresMaternal mortality ratio and neonatal mortality rate. ResultsMost countries have experienced increases in caesarean section rate during the study period. In the unadjusted analysis, there was a negative association between caesarean section rates and mortality outcomes for low caesarean section rates, especially among the least developed countries. After adjusting for HDI, this effect was much smaller and was only observed below a caesarean section rate of 5-10%. No important association between the caesarean section rate and maternal and neonatal mortality was observed when the caesarean section rate exceeded 10%. ConclusionsAlthough caesarean section is an effective intervention to save maternal and infant lives, based on the available ecological evidence, caesarean section rates higher than around 10% at the population level are not associated with decreases in maternal and neonatal mortality rates, and thus may not be necessary to achieve the lowest maternal and neonatal mortality.
Keywords Caesarean section rate
maternal mortality
neonatal mortality
xmlui.dri2xhtml.METS-1.0.item-coverage Hoboken
Language English
Sponsor UNDP
UNFPA
UNICEF
WHO
World Bank Special Programme of Research, Development and Research Training in Human Reproduction
Department of Reproductive Health and Research
World Health Organization, Geneva, Switzerland
Date 2016
Published in Bjog-An International Journal Of Obstetrics And Gynaecology. Hoboken, v. 123, n. 5, p. 745-753, 2016.
ISSN 1470-0328 (Sherpa/Romeo, impact factor)
Publisher Wiley
Extent 745-753
Origin http://dx.doi.org/10.1111/1471-0528.13592
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000373369000015
URI https://repositorio.unifesp.br/handle/11600/56165

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