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. 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

Margo S Harrison  1 , Omrana Pasha  2 , Sarah Saleem  2 , Sumera Ali  2 , Elwyn Chomba  3 , Waldemar A Carlo  4 , Ana L Garces  5 , Nancy F Krebs  6 , K Michael Hambidge  6 , Shivaprasad S Goudar  7 , Bhala Kodkany  7 , Sangappa Dhaded  7 , Richard J Derman  8 , Archana Patel  9 , Patricia L Hibberd  10 , Fabian Esamai  11 , Edward A Liechty  12 , Janet L Moore  13 , Dennis Wallace  13 , Elizabeth M Mcclure  13 , Menachem Miodovnik  14 , Marion Koso-Thomas  14 , Jose Belizan  15 , Antoinette K Tshefu  16 , Melissa Bauserman  17 , Robert L Goldenberg  1
Affiliations

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

Margo S Harrison et al. Acta Obstet Gynecol Scand. 2017 Apr.

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.

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Conflict of interest statement

Conflict of Interest

Data and presentation of information has not been influenced by the personal or financial relationship of the authors with other people or organizations. Authors have no financial or otherwise competing interests to disclose.

Figures

Figure 1
Figure 1
Cesarean section rates at Global Network sites, 2010–2015.
See this image and copyright information in PMC

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