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

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dc.citation.issue5
dc.citation.volume123
dc.contributor.authorYe, J.
dc.contributor.authorZhang, J.
dc.contributor.authorMikolajczyk, R.
dc.contributor.authorTorloni, Maria Regina [UNIFESP]
dc.contributor.authorGuelmezoglu, A. M.
dc.contributor.authorBetran, A. P.
dc.coverageHoboken
dc.date.accessioned2020-07-22T13:23:18Z
dc.date.available2020-07-22T13:23:18Z
dc.date.issued2016
dc.description.abstractObjectiveCaesarean 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.en
dc.description.affiliationShanghai Jiao Tong Univ, Xinhua Hosp, Sch Med, Shanghai Key Lab Childrens Environm Hlth,Minist E, 1665 Kong Jiang Rd, Shanghai 200092, Peoples R China
dc.description.affiliationWHO, World Bank Special Programme Res, UNICEF, UNFPA,UNDP,Dept Reprod Hlth & Res,Dev & Res Train, CH-1211 Geneva, Switzerland
dc.description.affiliationHelmholtz Ctr Infect Res, ESME Epidemiol & Stat Methods Res Grp, Braunschweig, Germany
dc.description.affiliationHannover Med Sch, Hannover, Germany
dc.description.affiliationUniv Fed Sao Paulo, Sao Paulo Sch Med, Brazilian Cochrane Ctr, Sao Paulo, Brazil
dc.description.affiliationUniv Fed Sao Paulo, Sao Paulo Sch Med, Dept Obstet, Sao Paulo, Brazil
dc.description.affiliationUnifespUniv Fed Sao Paulo, Sao Paulo Sch Med, Brazilian Cochrane Ctr, Sao Paulo, Brazil
dc.description.affiliationUnifespUniv Fed Sao Paulo, Sao Paulo Sch Med, Dept Obstet, Sao Paulo, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipUNDP
dc.description.sponsorshipUNFPA
dc.description.sponsorshipUNICEF
dc.description.sponsorshipWHO
dc.description.sponsorshipWorld Bank Special Programme of Research, Development and Research Training in Human Reproduction
dc.description.sponsorshipDepartment of Reproductive Health and Research
dc.description.sponsorshipWorld Health Organization, Geneva, Switzerland
dc.format.extent745-753
dc.identifierhttp://dx.doi.org/10.1111/1471-0528.13592
dc.identifier.citationBjog-An International Journal Of Obstetrics And Gynaecology. Hoboken, v. 123, n. 5, p. 745-753, 2016.
dc.identifier.doi10.1111/1471-0528.13592
dc.identifier.fileWOS000373369000015.pdf
dc.identifier.issn1470-0328
dc.identifier.urihttps://repositorio.unifesp.br/handle/11600/56165
dc.identifier.wosWOS:000373369000015
dc.language.isoeng
dc.publisherWiley
dc.relation.ispartofBjog-An International Journal Of Obstetrics And Gynaecology
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectCaesarean section rateen
dc.subjectmaternal mortalityen
dc.subjectneonatal mortalityen
dc.titleAssociation between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal dataen
dc.typeinfo:eu-repo/semantics/article
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