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Acta Obstet Gynecol Scand. 2017 Apr;96(4):410-420. doi: 10.1111/aogs.13098. Epub 2017 Mar 9.

A prospective study of maternal, fetal and neonatal outcomes in the setting of cesarean section in low- and middle-income countries.

Author information

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.

KEYWORDS:

Cesarean section; low- and middle-income countries; maternal morbidity; maternal mortality; neonatal morbidity; neonatal mortality

PMID:
28107771
PMCID:
PMC5665564
DOI:
10.1111/aogs.13098
[Indexed for MEDLINE]
Free PMC Article

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