What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies.
Cast your vote
You can rate an item by clicking the amount of stars they wish to award to this item.
When enough users have cast their vote on this item, the average rating will also be shown.
Your vote was cast
Thank you for your feedback
Thank you for your feedback
AuthorsBetran, Ana Pilar
Torloni, Maria Regina
Oladapo, Olufemi Taiwo
Souza, João Paulo
Vogel, Joshua Peter
Gülmezoglu, Ahmet Metin
MetadataShow full item record
AbstractIn 1985, WHO stated that there was no justification for caesarean section (CS) rates higher than 10-15% at population-level. While the CS rates worldwide have continued to increase in an unprecedented manner over the subsequent three decades, concern has been raised about the validity of the 1985 landmark statement. We conducted a systematic review to identify, critically appraise and synthesize the analyses of the ecologic association between CS rates and maternal, neonatal and infant outcomes. Four electronic databases were searched for ecologic studies published between 2000 and 2014 that analysed the possible association between CS rates and maternal, neonatal or infant mortality or morbidity. Two reviewers performed study selection, data extraction and quality assessment independently. We identified 11,832 unique citations and eight studies were included in the review. Seven studies correlated CS rates with maternal mortality, five with neonatal mortality, four with infant mortality, two with LBW and one with stillbirths. Except for one, all studies were cross-sectional in design and five were global analyses of national-level CS rates versus mortality outcomes. Although the overall quality of the studies was acceptable; only two studies controlled for socio-economic factors and none controlled for clinical or demographic characteristics of the population. In unadjusted analyses, authors found a strong inverse relationship between CS rates and the mortality outcomes so that maternal, neonatal and infant mortality decrease as CS rates increase up to a certain threshold. In the eight studies included in this review, this threshold was at CS rates between 9 and 16%. However, in the two studies that adjusted for socio-economic factors, this relationship was either weakened or disappeared after controlling for these confounders. CS rates above the threshold of 9-16% were not associated with decreases in mortality outcomes regardless of adjustments. Our findings could be interpreted to mean that at CS rates below this threshold, socio-economic development may be driving the ecologic association between CS rates and mortality. On the other hand, at rates higher than this threshold, there is no association between CS and mortality outcomes regardless of adjustment. The ecological association between CS rates and relevant morbidity outcomes needs to be evaluated before drawing more definite conclusions at population level.
CitationWhat is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. 2015, 12:57 Reprod Health
AffiliationHelmholtz Centre for infection research, Inhoffenstr. 7, 38124 Braunschweig, Germany.
CollectionsPublications of the AG (ESME)
The following license files are associated with this item:
Except where otherwise noted, this item's license is described as http://creativecommons.org/licenses/by-nc-sa/4.0/
- A prospective study of maternal, fetal and neonatal outcomes in the setting of cesarean section in low- and middle-income countries.
- Authors: Harrison MS, Pasha O, Saleem S, Ali S, Chomba E, Carlo WA, Garces AL, Krebs NF, Hambidge KM, Goudar SS, Kodkany B, Dhaded S, Derman RJ, Patel A, Hibberd PL, Esamai F, Liechty EA, Moore JL, Wallace D, Mcclure EM, Miodovnik M, Koso-Thomas M, Belizan J, Tshefu AK, Bauserman M, Goldenberg RL
- Issue date: 2017 Apr
- Cesarean section rates and maternal and neonatal mortality in low-, medium-, and high-income countries: an ecological study.
- Authors: Althabe F, Sosa C, Belizán JM, Gibbons L, Jacquerioz F, Bergel E
- Issue date: 2006 Dec
- Immediate versus deferred delivery of the preterm baby with suspected fetal compromise for improving outcomes.
- Authors: Stock SJ, Bricker L, Norman JE, West HM
- Issue date: 2016 Jul 12
- Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality.
- Authors: Molina G, Weiser TG, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Azad T, Shah N, Semrau K, Berry WR, Gawande AA, Haynes AB
- Issue date: 2015 Dec 1
- Planned caesarean section for women with a twin pregnancy.
- Authors: Hofmeyr GJ, Barrett JF, Crowther CA
- Issue date: 2015 Dec 19