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Lancet. 2010 Feb 6;375(9713):490-9. doi: 10.1016/S0140-6736(09)61870-5. Epub 2010 Jan 11.

Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08.

Collaborators (367)

Rathavy T, Savuth P, Somaly P, Somana N, Saroeun O, Rin M, Ly EM, Nary R, Phaly K, Sorphy T, Nara P, Chandavy T, Savy B, Varang O, Sokrathavy U, Vouchnea L, Ruyan P, Yanqiu G, Chuyun K, Ying P, Ling Q, Yuanying M, Qiong W, Guangping G, Yan Z, Ying W, Xiaoying L, Xinzuo C, Quansheng Q, Dan L, Li L, Huiying W, Xin Z, Yanli Z, Xiuli L, Sheng J, Xia C, Heping Y, Li F, Baolin Z, Dongxia L, Fang F, Qiuyun L, Hua Z, Yunxia Z, Qian B, Zhijuan Y, Jingfeng C, Ying W, Xulin H, Xiaojin Z, Xiuming J, lida L, Daqing J, Tan Z, Qihui F, Fei J, Chunyu Z, Yunfeng C, Yonghua L, Yinnv L, Lingxiu Z, Xiaoling Y, Lvsheng C, Xiuqing C, Yanhua W, Xiuqin W, Jie D, Feiyun Y, Xiaoying H, Xu L, Xiaofang Z, LiPing W, Fang C, Hui C, Li C, Xiaofei Y, Zhangxia L, Peng S, Huliang W, Peifei C, Guohua W, Shenhua Z, Shuhua D, Hongyun Z, Guizhen L, Li Y, Hongbin L, Jiazhen Z, Yangfang, Na L, Yujing Z, Juxiang Q, Chunli H, Liyan L, Mingyu Z, Zhiyun Y, Qin L, Yu Y, Zhongming Z, Suying C, Taorong L, Yunlong L, Kaixiang L, Jinhua W, Yuyan M, Heyou C, Yuzhuo D, Juhua Z, Guihua S, Shimin Y, Roy M, Kumar P, Sahlan S, Guleria K, Yadav R, Yadav I, Sharma N, Agrawal M, Kashap K, Choudhury S, Desai A, Patel VU, Saini HB, Desai MR, Thaker R, Gupta LP, Bhuvar FG, Baldania P, Mishra A, Gohiya R, Bedi N, Diwakar S, Budholia P, Jain RK, Dwivedi GP, Jain RK, Kambo I, Singh S, Sinha A, Dhillon BS, Singh R, Diaman N, Bhatia M, Nandi S, Dawar R, Jain I, Agarwal R, Singh A, Aggarwal D, Verma M, Arora SK, Agarwal B, Niwas R, Bhumbla U, Choudhury V, Dua A, Agrawal R, Kr Maurya A, Bhandula R, Sharma A, David A, Singhal R, Anerao K, Shah A, Bhavsar MM, Solanki R, Sanesara P, Pandya HA, Chauhan NR, Kansara V, Yadav P, Sanghavi V, Parmar H, Patel M, Vekariya N, Kalaji VP, Thomas S, Bhuvar R, Chopada B, Baldania B, Anjariya RA, Rangari S, Badve N, Chadokar T, Sahu R, Srivastava G, Pujari PD, Verma N, Tiwari AK, Sharma C, Tiwari L, Parashar S, Bhramabhatt D, Patel S, Yadu R, Mishra D, Varma D, Bhargava M, Rajeshwari D, Lakhwani P, Khanna A, Shrivastava SP, Singh N, Mori R, Fujimura M, Harada S, Horiuchi S, Kubo T, Nakamura Y, Takahashi K, Furuta M, Nagai S, Mitsuichi C, Higuchi Y, Suzuki M, Ito T, Shimada N, Abe S, Iino K, Ueda N, Miyake K, Yamasaki F, Yonemoto N, Amamiya S, Saito K, Saito M, Shrestha N, Sjrestha B, Sharma S, Sharma J, Uprety D, Jha UK, Mishra Y, Yadav D, Singh GB, Shrestha AP, Ranjit S, Sagar S, Amatya AN, Shrestha B, Subedi S, Joshi A, Siwakoti P, Shankar Ranjit JS, Mukhiya P, Subba K, Bhandari K, Sah P, Shrestha A, Rauniyar SK, Khanal A, Sigdel M, Rai M, Chaudhary L, Khatri S, Mahato AK, Shrestha K, Shahi K, Silwal P, Rimal J, Limbu A, Rai A, Adhikari D, Shrestha T, Shrestha B, Germar MJ, Padolina C, Abalos Z, Capito L, Reyes RD, Ramos N, Martin C, Cuartero V, Gamilla Z, San Pedro A, Austria B, Concepcion T, Nito E, Babala G, Estuart D, Cunanan G, Busuego R, Bugashi A, Estuart J, Goitain J, Gomez C, Juban H, Torralba E, Laderas A, Attygalle DE, Karunaratne V, Hemachandra DK, Karandagoda KK, Perera UL, Gunawardane WG, Muhandiram L, De Lanerolle DL, Denivage SL, Senevirathna RM, Gunasekera PL, Siribaddana P, Gunasekera VR, Mediwaka MW, Manjula SM, Chandrarathna M, Kadahettige SJ, Shaheed PM, Arulanandem K, Vithanage RY, Wickramasinghe KH, Taneepanichskul S, Udomprasertgul V, Tangusaha C, Rawangban B, Thamkhamtho M, Kovavisarach E, Iamurairat W, Liabsuetrakul T, Wannaro P, Promvijit T, Liabsuetrakul T, Ampant P, Angkawanit P, Laosatienkij W, Veerasangpong T, Sereekajornjaru P, Roonjaroen R, Boonbundarlchai R, Wimuktayon S, Deelertyuenyong N, Chaemthavorn S, Choenkhwuanma S, Theppitaksak B, Nguyen DH, Luu TH, Le H, Nguyen HL, Dang TH, Le H, Le TT, Nguyen TB, Nguyen le HP, Nguyen TL, Nguyen TB, Nguyen TQ, Nguyen TB, Nguyen DT, Le TH, Nguyen TQ, Huynh TB, Lo TK, Phan HK, Nguyen Dl, Nguyen NL, Nguyen VT, Duong LD, Pham PL, Nong MH, Nguyen AT, Vu BN, Truong TH, Doan TH, Trinh KL, Nguyen TT, Trinh TH, Lai TT.

Author information

1
Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Erratum in

  • Lancet. 2010 Dec 4;376(9756):1902.

Abstract

BACKGROUND:

There has been concern about rising rates of caesarean section worldwide. This Article reports the third phase of the WHO global survey, which aimed to estimate the rate of different methods of delivery and to examine the relation between method of delivery and maternal and perinatal outcomes in selected facilities in Africa and Latin America in 2004-05, and in Asia in 2007-08.

METHODS:

Nine countries participated in the Asia global survey: Cambodia, China, India, Japan, Nepal, Philippines, Sri Lanka, Thailand, and Vietnam. In each country, the capital city and two other regions or provinces were randomly selected. We studied all women admitted for delivery during 3 months in institutions with 6000 or fewer expected deliveries per year and during 2 months in those with more than 6000 deliveries. We gathered data for institutions to obtain a detailed description of the health facility and its resources for obstetric care. We obtained data from women's medical records to summarise obstetric and perinatal events.

FINDINGS:

We obtained data for 109 101 of 112 152 deliveries reported in 122 recruited facilities (97% coverage), and analysed 107 950 deliveries. The overall rate of caesarean section was 27.3% (n=29 428) and of operative vaginal delivery was 3.2% (n=3465). Risk of maternal mortality and morbidity index (at least one of: maternal mortality, admission to intensive care unit [ICU], blood transfusion, hysterectomy, or internal iliac artery ligation) was increased for operative vaginal delivery (adjusted odds ratio 2.1, 95% CI 1.7-2.6) and all types of caesarean section (antepartum without indication 2.7, 1.4-5.5; antepartum with indication 10.6, 9.3-12.0; intrapartum without indication 14.2, 9.8-20.7; intrapartum with indication 14.5, 13.2-16.0). For breech presentation, caesarean section, either antepartum (0.2, 0.1-0.3) or intrapartum (0.3, 0.2-0.4), was associated with improved perinatal outcomes, but also with increased risk of stay in neonatal ICU (2.0, 1.1-3.6; and 2.1, 1.2-3.7, respectively).

INTERPRETATION:

To improve maternal and perinatal outcomes, caesarean section should be done only when there is a medical indication.

FUNDING:

US Agency for International Development (USAID); UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Switzerland; Ministry of Health, Labour and Welfare of Japan; Ministry of Public Health, China; and Indian Council of Medical Research.

PMID:
20071021
DOI:
10.1016/S0140-6736(09)61870-5
[Indexed for MEDLINE]

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