Nav: Home

Death rates from cesarean section far higher in developing countries

March 28, 2019

Caesarean 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.

The analysis of data from 12 million pregnancies, published in The Lancet, finds that maternal deaths in LMICs are 100 times higher than in some high-income countries, and a third of all babies in some regions do not survive caesarean section.

First author Dr Soha Sobhy from Queen Mary University of London said: "To our knowledge, this is the largest and most comprehensive study to-date on the risks of death following caesarean section. The outcomes for women in low and middle-income countries are far worse than we expected.

"In sub-Saharan Africa, one in 100 women who has a caesarean section will die - 100 times more than women in the UK. The outcomes for their babies are even worse, with eight per cent not surviving longer than a week."

Lead author Professor Shakila Thangaratinam from Queen Mary University of London added: "Caesarean sections are the most commonly performed operation worldwide. They are meant to be life saving for both mother and baby, but because of many factors, such as poor access, late referrals, inappropriate procedures, poor resources and training, this is not always the case.

"Now that we know the risk factors and countries associated with poor outcomes, we can make a more targeted effort to improve conditions for mothers globally, so that timely and safe caesarean sections can be done wherever they are needed."

Every year 300,000 women die during childbirth, 99 per cent of which are from LMICs. Timely access to caesarean section when needed is required for safe childbirth, but procedures are being performed 'too little, too late', or 'too many, too soon'.

The analysis looked at data from 196 studies from 67 LMICs, covering 12 million pregnancies, and found that:
  • The risk of maternal death in women in LMICs undergoing caesarean section was 7.6 per 1,000 procedures - around 100-fold higher than the UK (8/100,000)

  • The highest burden was in sub-Saharan Africa (10.9/1,000)

  • The overall rate of stillbirth in babies born by caesarean section was 56.6 per 1,000, with the highest rates in sub-Saharan Africa (82.5/1,000)

  • The perinatal death rate (stillbirths and deaths in the first week of life) was 84.7 per 1,000 caesarean sections, with the highest rates in Middle East and North Africa (354.6/1,000)

  • A quarter of all women in LMICs who died while giving birth had undergone caesarean section (23.8 per cent)

  • Women undergoing emergency caesarean section in LMICs were twice more likely to die than those delivering by elective caesarean section. The odds were increased 12-fold when caesarean section was performed in advanced labour at full dilatation of the cervix (second stage) than in the first stage

  • Perinatal deaths were increased 5-fold with emergency vs. elective caesarean sections, and 10-fold when undertaken in the second vs. first stage of labour

  • Maternal death rates were particularly high in countries with very low caesarean section rates, highlighting the problems with too little access, too late

  • A third of all deaths following caesarean section were attributed to postpartum haemorrhage (32 per cent), pre-eclampsia (19 per cent) and sepsis (22 per cent), and 14 per cent to anaesthesia related causes.
Based on these findings, the researchers are calling on policy makers and healthcare professionals to improve access to surgery, promote appropriate use of the procedure, provide safe surgical environments, and increase neonatal resuscitation to help improve outcomes to babies.

The team also highlight that training in labour management needs to cover why caesarean sections are carried out, in order to reduce inappropriate caesarean sections, and promote a reduction in caesarean sections performed in the second stage of labour, which are the most risky.

The finding that postpartum haemorrhage was the commonest cause of maternal death following caesarean section, highlights gaps in resource and skills to manage massive obstetric haemorrhage, and a need for specific training in this area.

The work was carried out at Barts Research Centre for Women's Health, based at Queen Mary University of London, funded by Barts Charity, and in collaboration with the World Health Organization.

Francesca Gliubich, Director of Grants at Barts Charity said: "The Barts Research Centre for Women's Health is undertaking many important studies and Barts Charity are proud to fund their work. This latest research will help to inform global health policies around Caesarean sections and help to avoid the preventable deaths of both mothers and babies."

The study was also funded by the National Institute for Health Research (NIHR), Ammalife Charity and the ELLY Appeal. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

The findings are limited by the differences in the characteristics of population and the team could not adjust for underlying obstetric and socio economic factors. It was also not possible to determine if the adverse outcomes following caesarean section were due to the procedure or from a pre-existing risk factor. Very few studies were published in some regions such as Europe and central Asia and Middle East and North Africa, and may affect the generalisability of the findings.
-end-
For more information, please contact:

Joel Winston
Public Relations Manager (School of Medicine and Dentistry)
Queen Mary University of London
j.winston@qmul.ac.uk
Tel: +44 (0)20 7882 7943 / +44 (0)7968 267 064

Notes to the editor

  • A full table of maternal death data by country and maps can be found on Dropbox here: http://bit.ly/2HV9eLM (other tables and manuscript available on request)

  • Research paper: 'Maternal and perinatal mortality and complications associated with caesarean section in low and middle-income countries: A systematic review and meta-analysis of 12 million pregnancies'. Soha Sobhy MD, David Arroyo-Manzano MSc, Nilaani Murugesu Bsc, Gayathri Karthikeyan MD, Vinod Kumar MS, Inderjeet Kaur MSc, Evita Fernandez MD, Sirisha Gundabattula, MD, Ana Pilar Betran PhD, Khalid Khan MSc, Javier Zamora PhD, Shakila Thangaratinam PhD1. The Lancet. DOI: 10.1016/S0140-6736(18)32386-9

Available here after the embargo lifts: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32386-9/fulltext

About Queen Mary University of London

At Queen Mary University of London, we believe that a diversity of ideas helps us achieve the previously unthinkable.

In 1785, Sir William Blizard established England's first medical school, The London Hospital Medical College, to improve the health of east London's inhabitants. Together with St Bartholomew's Medical College, founded by John Abernethy in 1843 to help those living in the City of London, these two historic institutions are the bedrock of Barts and The London School of Medicine and Dentistry.

Today, Barts and The London continues to uphold this commitment to pioneering medical education and research. Being firmly embedded within our east London community, and with an approach that is driven by the specific health needs of our diverse population, is what makes Barts and The London truly distinctive.

Our local community offer to us a window to the world, ensuring that our ground-breaking research in cancer, cardiovascular and inflammatory diseases, and population health not only dramatically improves the outcomes for patients in London, but also has a far-reaching global impact.

This is just one of the many ways in which Queen Mary is continuing to push the boundaries of teaching, research and clinical practice, and helping us to achieve the previously unthinkable.

About the National Institute for Health Research

The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:
  • Funds, supports and delivers high quality research that benefits the NHS, public health and social care

  • Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research

  • Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future

  • Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services

  • Partners with other public funders, charities and industry to maximise the value of research to patients and the economy

The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR commissions applied health research to benefit the poorest people in low- and middle-income countries, using Official Development Assistance funding.

Queen Mary University of London

Related Caesarean Section Articles:

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.
The Lancet: Caesarean section use has almost doubled globally since 2000
Peer-reviewed / Modelling and review **Country-level data and spokespeople available** Globally, 21 percent births are delivered via C-section, higher than the level thought required for medical purposes (10-15 percent).
In childbirth, when to begin pushing does not affect C-section rates
Obstetricians have differing opinions about when women should begin pushing during labor and whether the timing of pushing increases the likelihood of a cesarean section.
Inducing labor at 39 weeks decreases need for cesarean section
Inducing labor in healthy women at 39 weeks into their pregnancy reduces the need for cesarean section and is at least as safe for mother and baby as waiting for spontaneous labor.
Pre-delivery risk factors associated with C-section infections
Having a prior cesarean section (C-section), smoking, illicit drug use, and obesity increase the likelihood of developing an infection during a C-section delivery, according to new research presented at the 45th Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC).
Salvaging blood during cesarean section may have potential in emergency procedures
Using cell salvage, the reinfusion of red blood cells lost during surgery, did not lead on average to a statistically significant reduction in the rates of blood transfusion needed by all women undergoing caesarean section, according to a study published this week in PLOS Medicine by Khalid Khan from Queen Mary University of London, UK, and colleagues.
More Caesarean Section News and Caesarean Section Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Reinvention
Change is hard, but it's also an opportunity to discover and reimagine what you thought you knew. From our economy, to music, to even ourselves–this hour TED speakers explore the power of reinvention. Guests include OK Go lead singer Damian Kulash Jr., former college gymnastics coach Valorie Kondos Field, Stockton Mayor Michael Tubbs, and entrepreneur Nick Hanauer.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at Radiolab.org/donate.