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

Acta Obstetricia et Gynecologica Scandinavica - Tập 96 Số 4 - Trang 410-420 - 2017
Margo S. Harrison1, Omrana Pasha2, Sarah Saleem2, Sumera Aziz Ali2, Elwyn Chomba3, Waldemar A. Carlo4, Ana L. Garcés5, Nancy F. Krebs6, K. Michael Hambidge6, Shivaprasad S. Goudar7, Bhala Kodkany7, Sangappa Dhaded7, Richard J. Derman8, Archana Patel9, Patricia L. Hibberd10, Fabian Esamai11, Edward A. Liechty12, Janet Moore13, Dennis Wallace13, Elizabeth M. McClure13, Steve N. Caritis14, Marion Koso‐Thomas14, José M. Belizán15, Antoinette Tshefu16, Melissa Bauserman17, Robert L. Goldenberg1
1Department of Obstetrics and Gynecology, Columbia University , New York, NY , USA.
2Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
3University Teaching Hospital, University of Zambia, Lusaka, Zambia
4Division of Neonatology, University of Alabama, Birmingham, AL, USA
5Planning Unit, Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
6School of Medicine, University of Colorado, Denver, CO, USA
7Jawaharlal Nehru Medical College (KLE University), Belgaum, India
8Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA;
9Lata Medical Research Foundation, Nagpur, India
10School of Public Health, Boston University, Boston MA USA
11School of Medicine, Moi University, Eldoret, Kenya
12School of Medicine, Indiana University, Indianapolis, IN, USA
13RTI International, Durham, NC, USA
14Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
15Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
16Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
17Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA

Tóm tắt

AbstractIntroductionCesarean 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 methodsA 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.ResultsAcross 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.ConclusionsCS 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.

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Acta Obstetricia et Gynecologica Scandinavica

Tập 96 Số 4

410-420

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