Maternal mortality and the rising cesarean rate (original) (raw)

Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality

JAMA, 2015

Based on older analyses, the World Health Organization (WHO) recommends that cesarean delivery rates should not exceed 10 to 15 per 100 live births to optimize maternal and neonatal outcomes. To estimate the contemporary relationship between national levels of cesarean delivery and maternal and neonatal mortality. Cross-sectional, ecological study estimating annual cesarean delivery rates from data collected during 2005 to 2012 for all 194 WHO member states. The year of analysis was 2012. Cesarean delivery rates were available for 54 countries for 2012. For the 118 countries for which 2012 data were not available, the 2012 cesarean delivery rate was imputed from other years. For the 22 countries for which no cesarean rate data were available, the rate was imputed from total health expenditure per capita, fertility rate, life expectancy, percent of urban population, and geographic region. Cesarean delivery rate. The relationship between population-level cesarean delivery rate and mat...

Trend in major neonatal and maternal morbidities accompanying the rise in the cesarean delivery rate

The aim of the study was to explore a cesarean delivery rate (CDR) beyond which major neonatal and maternal morbidities may outweigh the benefits of the procedure itself. A retrospective population-based cohort study was conducted at a single university teaching hospital between 1993 and 2012. Pregnant women who delivered at a gestational age of 23 weeks or more were included. Data including delivery mode, brachial plexus injury (BPI), neonatal encephalopathy (NE), placenta accreta (PA), blood transfusion (BT), and cesarean hysterectomy (CH) for each year were extracted, plotted, and trends analyzed. The Cochran-Armitage Trend Test was used to identify trends and correlations. Overall, 83,806 deliveries took place during this period. CDR increased from 10.9% to 21.7% (p < 0.001). Significant decreases in the incidence of BPI (p < 0.001) and NE (p = 0.006) were observed. At CDRs of 13.6% and 20%, there was no further significant decrease in the incidence of BPI and NE, respectively. The incidence of BT increased significantly (p < 0.001) while the increase in the incidence of PA was not significant (p = 0.06) nor the change in the incidence of CH (p = 0.4). A CDR of 20% may still confirm additional beneficial effect on major perinatal morbidities without a significant increase in the incidence of PA.

Maternal Morbidity During Hospitalization for Delivery

Obstetrics & Gynecology, 2011

To estimate nationally representative incidence rates of maternal morbidities and to examine if the incidence of maternal morbidity increased during a 4-year study period. METHODS: We conducted a population-based retrospective cohort study of women delivering in hospitals in Ireland between 2005 and 2008 using nationally representative hospital discharge data from the Hospital In-Patient Enquiry data set. Using singleton deliveries, we categorized International Classification of Diseases 10, Australian Modification diagnostic codes into 38 clinically relevant maternal morbidity groups and assessed the incidence of morbidities potentially affecting labor, delivery, and the puerperium. Significant trends in morbidity over the course of the study period were determined using Cochran-Armitage tests. RESULTS: Exclusive of cesarean delivery, approximately one in six women (17.2%) had a maternal morbidity diagnosed during Hospitalization. When cesarean delivery was included as an additional indicator of morbidity, more than one third (35.6%) had a maternal morbidity diagnosed. The percentage of women with either hemorrhage and genital tract trauma (6.5%) or pregnancyinduced conditions (6.4%) diagnosed were similar. Overall, 4.5% of women had nonacute or chronic conditions diagnosed, 1.6% had infections diagnosed, and 0.6% had acute medical conditions diagnosed. Between 2005 and 2008, rates significantly (P<.001) increased for postpartum hemorrhage, pelvic and perineal trauma, and gestational diabetes. CONCLUSION: Maternal morbidities in Ireland are common and changing, underscoring the benefits of continuous comprehensive examination of maternity care services for all women during childbirth to address treatment of morbidities and to potentially prevent new morbidities.

Maternal Mortality With Cesarean Delivery: A Literature Review

Seminars in Perinatology, 2006

OBJECTIVE We sought to determine the present-day risk of maternal death with cesarean delivery. METHODS We reviewed the recent literature (years in analysis: 1975-2001) identified in a literature search and included data from the Royal College of Obstetricians and Gynaecologists. FINDINGS There were no publications with an ideal trial design and adequate power to establish the relationship between maternal mortality and method of delivery. Three studies, including the one randomized control trial included in analysis, and the Royal College of Obstetricians and Gynaecologists data suggest no significant difference in maternal mortality with cesarean delivery as compared with vaginal delivery. CONCLUSIONS The strongest publications suggest there may not be an increased risk of maternal death with cesarean delivery as compared with vaginal delivery; however, there are inadequate data to accurately demonstrate the present-day risk of maternal death with cesarean delivery.

Maternal mortality after cesarean section in the Netherlands

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2018

Maternal mortality after cesarean section in the Netherlands Athanasios F. Kallianidis, Joke M. Schutte, Jos van Roosmalen, Thomas van den Akker. Objectives: Maternal mortality is rare in high-resource settings. This hampers studies of the association between maternal mortality and mode of birth, although this topic remains of importance, given the changing patterns in mode of birth with increasing cesarean section rates in most countries. Purpose of this study was to examine incidence of cesarean sectionrelated maternal mortality in the Netherlands and association of surgery with the chain of morbid events leading to death. Study Design: We performed a retrospective cohort study using the Confidential Enquiry into Maternal Deaths, including all 2,684,946 maternities in the Netherlands between January 1 st , 1999, and December 31 st , 2013, registered in the Dutch Perinatal Registry. All available medical records of cases reported to the Dutch Maternal Mortality and Severe Morbidity Audit Committee were assessed by two researchers, and one or two additional experts in case of contradicting opinions, based on a set of pre-identified clinical criteria. Main outcome measures were (1) incidence and relative risk of maternal death following cesarean section and vaginal birth and (2) incidence of death directly related to cesarean section and death in which cesarean section was one of the contributing factors. Results: Risk of death after cesarean section was 21.9 per 100.000 cesarean sections (86/393,443) versus 3.8 deaths per 100.000 vaginal births (88/2,291,503): Relative Risk (RR) 5.7 (95% Confidence Interval [CI] 4.2-7.7). Death directly related to complications of cesarean section occurred in 8/86 women: 2 per 100,000 cesarean sections. With addition of 43 women in which cesarean section did not initiate, but contributed to the chain of events leading to mortality, risk of death increased to 13 per 100,000 cesarean sections (51/393,443; RR 3.4; 95%CI 2.4-4.8). At the start of cesarean section, pre-existing morbidity was present in 70/86 women (81.4%). Conclusions: Compared to vaginal birth, maternal mortality after cesarean section was three times higher following exclusion of deaths that had no association with surgery. In 3 approximately one in ten deaths after cesarean section, surgery did in fact initiate the chain of morbid events.

Correlation between cesarean section and perinatal mortality rate

Acta Medica Saliniana, 2019

Objectives: cesarean section rates show a wide variation among countries, ranging from 0,4-40%, and continuous rise. Our aim was to test hypothesis that higher Cesarean rate than 15% does not correlates with lower perinatal mortality rate. Methods: We analysed 18-year period with high-quality cesarean delivery and perinatal mortality rates information data. Data were analised by Chi-square test with Yate's correction for large values. Results: Cesarean section rates has increasing trend. In first six-years of observed period (1998-2003) mean cesarean section rate was 17,24%, in second (2004-2009) 19,33% and in third (2010-2015) 23,97%. In observed period mean perinatal mortality rate was 9,90‰, with fluctuation of 20,70‰ to 3,82‰. In first six-years of observed period (1998-2003) mean perinatal mortality rate was 13,81‰, in second (2004-2009) 8,28‰ and in third (2010-2015) 7,46‰. These data clearly showed that increase of cesarean section rate more than 19,33% is not correlate with decreasing od perinatal mortality. Conclusion: Despite many suggestions that improvement in perinatal mortality does not necessarily rely upon an ever-increasing cesarean section rate and recommendation by World Health Organisation that cesarean section rate should not exceed 10-15 percent to optimise neonatal outcomes, this recommendation may be too low, and suggests rate of 19%.

The reasons of rising trend of cesarean section rate year after year. A retrospective study

International Journal of Nursing and Midwifery, 2015

Cesarean section is a surgical procedure which allows the child to birth through uterus incision. Cesarean birth is a procedure that gives resolve problems such as maternal and fetal complications. To study the incidence of cesarean birth, 1982 to 2000 with 2011 to 2013 years were compared to determine indications that contribute to the trend of the increasing number of cesarean deliveries. We studied the clinical charts of 2011 to 2013 from the statistic department of Maternity Hospital "Koço Gliozheni" Tiranë, Albania. For statistical analysis, Statistical Package for the Social Science (SPSS) 11.5 package was used. This is a descriptive study and values will be presented in frequency and percentage. Study of clinical charts of 2011 to 2013 resulted in an average rate of cesarean deliveries of approximately 32.3%. In the year 1982 to 1984, the percentage of cesarean birth was approximately 8.7%, while in 1999 to 2000 the percentage of cesarean birth was approximately 21.7%. Indications that are most important in this study that have contributed to an increase in the number of cesarean births are preeclampsia (9.2%), fetal suffering (13.9%), premature rupture of membranes (9.8%) and the indication which has greater influence in the rising rate of cesarean delivery is previous cesarean births (36.5%). The most frequent reasons for cesarean births in the center where the study was conducted for years January, 2011 till December, 2013 are: previous cesarean section, preeclampsia, fetal suffering. So, previous cesarean births are the most important factor in making decisions about the way of delivery, while in 1982 to 1984 the important factor was fetal suffering. Previous cesarean birth and multiple pregnancies (due to the increased number of in vitro fertilization) represent a growing trend. However, this high percentage of cesarean births in our center is unwarranted, so physicians should be very careful when they select patients for cesarean section. Careful monitoring of the fetus will help in reducing cesarean birth rate in our hospital.