Cesarean section should only be done when medically indicated: Results from the WHO global maternal survey

January 11, 2010

Data from the WHO global survey on maternal and perinatal health shows that risk of maternal death and serious complications is higher for women undergoing caesarean section that is not medically indicated than for those where there is a medical indication. Thus, to improve medical outcomes, caesarean section should be done only when there is a medical indication. The findings of the survey are reported in an Article Online First (www.thelancet.com) and in an upcoming edition of The Lancet, written by Dr A Metin Gülmezoglu, Department of Reproductive Health and Research, WHO, Switzerland, and colleagues.

The survey took data from nine Asian countries: 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. A detailed description of each health facility, and its resources for obstetric care, was obtained. Women's medical records were also scrutinised to summarise obstetric and perinatal events.

Data was obtained for 109 101 of 112 152 deliveries reported in 122 recruited facilities (97% coverage), and 107 950 deliveries were studied. The overall rate of caesarean section was 27.3% . The overall rate of operative vaginal delivery (which includes vacuum and forceps assisted vaginal deliveries) was 3.2%. 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 both operative vaginal delivery and caesarean section in various scenarios. The increased risk, compared with normal birth, was for operative vaginal delivery 2.1 times, antepartum caesarean without indication 2.7; antepartum caesarean with indication 10.6, intrapartum without indication 14.2; intrapartum with indication 14.5. For breech presentation, caesarean section reduced the risk of perinatal mortality--both for antepartum (by 80%) and intrapartum (by 70%) caesarean deliveries; but caesarean section in this situation also increased risk of stay in neonatal ICU (doubled for both antepartum and intrapartum deliveries).

The authors say: "In the 122 Asian health facilities studied, more than one in four women underwent caesarean section. Facilities in China, Sri Lanka, Vietnam, and Thailand had higher aggregated rates of caesarean section than did those in Cambodia, India, Japan, Nepal, and the Philippines. Operative vaginal delivery and caesarean section were independently associated with increased risk of maternal mortality and morbidity index. Caesarean section without a medical indication was associated with increased risk of maternal mortality and morbidity. Caesarean section for breech presentation was associated with improved perinatal outcomes."

They conclude: "Caesarean section should be done only when there is a medical indication to improve the outcome for the mother or the baby. Women and their carers who plan to undertake caesarean section delivery should discuss the potential risks to make an informed decision if they still wish to have a caesarean delivery."

In an accompanying Comment, Dr Yap-Seng Chong, Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, and Dr Kenneth Y C Kwek, Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, say: "There is little wrong with medical interventions when indicated, but for those who are still inclined to consider caesarean delivery a harmless option, they need to take a cold hard look at the evidence against unnecessary caesarean section."
-end-
Dr A Metin Gülmezoglu, Department of Reproductive Health and Research, WHO, Switzerland. T) +41 22 791 3417 E) gulmezoglum@who.int

Dr Yap-Seng Chong, Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. T) +65 98219326 E) obgcys@nus.edu.sg

For full Article and Comment, see: http://press.thelancet.com/whoasia.pdf

Lancet

Related Caesarean Section Articles from Brightsurf:

Risk of childhood asthma by caesarean section is mediated through the early gut microbiome
New study highlights long-term perturbations of the early gut microbiome as a possible mechanism for the observed association between caesarean section and increased risk of developing asthma.

During COVID-19 first wave, the proportion of caesarean section deliveries done under
New research from north-west England published in Anaesthesia (a journal of the Association of Anaesthetists) shows that during the first wave of COVID-19, the proportion of caesarean section deliveries carried out under general anaesthesia approximately halved, from 7.7% to 3.7%.

Caesarean birth, prolonged labour influence infant gut bacteria, risk of childhood obesity
Events at birth may affect the microbes living in a baby's gut during the first few months of life, leading to a higher risk of childhood obesity and allergies, according to a new study published in the journal Gastroenterology.

Fecal transplantation can restore the gut microbiota of C-section babies
Birth by Cesarean section is detrimental to normal gut microbiota development.

Women who deliver by C-section are less likely to conceive subsequent children
Women who deliver their first child by cesarean section (C-section) are less likely to conceive a second child than those who deliver vaginally, despite being just as likely to plan a subsequent pregnancy, according to Penn State College of Medicine researchers.

Caesarean birth has little impact on children developing allergies
A caesarean birth had little impact on whether a child would go onto develop allergies, a new study has shown.

Different views on vaginal birth after previous caesarean section (VBAC)
There is considerable variations in different countries┬┤ health care systems and professionals in the views on vaginal birth after previous caesarean section (VBAC), according to a European study.

Outcomes of birth options after a previous cesarean section
A large cohort study of women who have had one or more previous cesarean sections suggests that attempting a vaginal birth in a subsequent pregnancy is associated with higher health risks to both the mother and the infant than electing for another cesarean.

Death rates from cesarean section far higher in developing countries
Cesarean sections are disproportionately threatening the lives of women and babies in low and middle-income countries (LMIC), according to a study led by Queen Mary University of London.

Altered microbiome after caesarean section impacts baby's immune system
Together with colleagues from Sweden and Luxembourg, scientists from the Luxembourg Centre for Systems Biomedicine (LCSB) of the University of Luxembourg have observed that, during a natural vaginal birth, specific bacteria from the mother's gut are passed on to the baby and stimulate the baby's immune responses.

Read More: Caesarean Section News and Caesarean Section Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.