Association between Maternal Mortality and Cesarean Section: Turkey Experience

Uzunçakmak, Cihangir; Özçam, Hasene

doi:10.1371/journal.pone.0166622

Cited by 18 publications

(11 citation statements)

References 13 publications

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“…A weak and statistically non-signi cant inverse linear association was observed between MMR and CS rate at national level, although there were signi cant regional disparities. Our ndings in these regions are supported by a study in Turkey, where an inverse association was observed between maternal mortality and CS rates 42 . This may be explained by the fact that most often CS is performed in response to emergency medical complications that saved lives of most women 43 .…”

Section: Discussionsupporting

confidence: 88%

Association between maternal mortality and caesarean section in Ethiopia: A national cross-sectional study

Bali

Chojenta

Taddele

et al. 2020

Preprint

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Background Several studies concluded that there is a reduction of maternal deaths with improved access to caesarean section, while other studies showed the existence of a direct association between the two variables. In Ethiopia, literature about the association between maternal mortality and caesarean section is scarce. This study was aimed to assess the association between maternal mortality ratios and caesarean section rates in hospitals in Ethiopia. Methods Analysis was done of a national maternal health dataset of 293 hospitals that accessed from the Ethiopian Public Health Institute. Hospital specific characteristics, maternal mortality ratios and caesarean section rates were described. Pearson’s correlation coefficient was used to determine the direction of association between maternal mortality ratios and caesarean section rate, taking regions into consideration. Presence of a linear association between these variables was declared statistically significant at p-value < 0.05. Results The overall maternal mortality ratio in Ethiopian hospitals was 149 (95% CI: 136–162) per 100,000 live births. There was significant regional variation in maternal mortality ratios, ranging from 74 (95% CI: 51–104) per 100,000 live births in Tigray region to 548 (95% CI: 251-1,037) in Afar region. The average annual caesarean section rate in hospitals was 20.3% (95% CI: 20.2–20.5). The highest caesarean section rate of 38.5% (95% CI: 38.1–38.9) was observed in Addis Ababa, while the lowest rate of 5.7% (95% CI: 5.2–6.2) occurred in Somali region. At national level, a statistically non-significant inverse association was observed between maternal mortality ratios and caesarean section rates. Similarly, unlike in other regions, there were inverse associations between maternal mortality ratios and caesarean section rates in Addis Ababa, Afar Oromia and Somali, although associations were not statistically significant. Conclusions At national level, a statistically non-significant inverse association was observed between maternal mortality ratios and caesarean section rates in hospitals, although there were regional variations. Additional studies with a stronger design should be conducted to assess the association between population-based maternal mortality ratios and caesarean section rates.

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Section: Discussionsupporting

confidence: 88%

Association between maternal mortality and caesarean section in Ethiopia: A national cross-sectional study

Bali

Chojenta

Taddele

et al. 2020

Preprint

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“…Only few studies have assessed cesarean section-related mortality on a nationwide scale. [11][12][13][14][15][16] The Netherlands have seen an increase in cesarean section rate from 10.8% in 1999 to 16.6% in 2015, although still lower than in almost any other high-income country at that time. 10,17 Confidential Enquiries into Maternal Deaths revealed that the maternal mortality ratio (MMR) rose from 9.7 to 12.1 per 100,000 live births between the time frames 1983-1992 and 1992-2005.…”

Section: Introductionmentioning

confidence: 99%

Maternal Mortality After Cesarean Section in the Netherlands

Kallianidis

Schutte²,

Roosmalen³

et al. 2019

Obstetrical &Amp; Gynecological Survey

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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.

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“…1 Access to c-section delivery is essential in reducing unnecessary maternal and neonatal deaths 2 and increased access to c-section care has contributed to the rapid decrease in maternal mortality worldwide over the last decade. 3,4 Still, sub-Saharan African women continue to have a higher risk of dying during childbirth than women anywhere else in the world. 5 Although there has been an increase in c-section rates globally, 6,7 only 3.5% of newborns are delivered via c-section in sub-Saharan Africa, 6 which is below the 10% rate recommended by the World Health Organization to reduce maternal and neonatal mortality.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Management and Outcomes After Cesarean Section—A Cross-Sectional Study From Rural Rwanda

Mazimpaka

Uwitonze

Cherian

et al. 2020

Journal of Surgical Research

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Background: Cesarean sections (c-sections), the most common surgical procedures performed worldwide, are essential in reducing maternal and neonatal deaths. There is a paucity of research studies on c-section care and outcomes in rural African settings. The objective of this study was to describe demographic characteristics, clinical management, and maternal and neonatal outcomes among women receiving c-sections at Kirehe District Hospital (KDH) in rural Rwanda. Methods: This retrospective cohort study included all women aged 18 y residing in KDH catchment area who delivered by c-section at KDH between April 1 and September 30, 2017. Demographic and clinical characteristics of these women and their newborns were collected using patient interviews and medical chart extraction. Descriptive analyses were performed, and frequency and percentages are reported. Results: Of the 621 women included in the study, 45.7% (n ¼ 284) were aged 25-34 y; 42.2% (n ¼ 262) were married; 67.5% (n ¼ 419) had primary education; and 75.7% (n ¼ 470) were farmers by occupation. Burundian refugees living in the nearby Mahama Refugee Camp comprised 13.7% (n ¼ 85) of the study population. The most common indication for csection was having undergone a c-section previously (31.9%, n ¼ 198), followed by acute fetal distress (30.8%, n ¼ 191). Among those with previous c-section as the sole indication for surgery, 85.4% presented as either urgent or emergent cases. Postoperatively, 67.7%

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Association between Maternal Mortality and Cesarean Section: Turkey Experience

Cited by 18 publications

References 13 publications

Association between maternal mortality and caesarean section in Ethiopia: A national cross-sectional study

Association between maternal mortality and caesarean section in Ethiopia: A national cross-sectional study

Maternal Mortality After Cesarean Section in the Netherlands

Perioperative Management and Outcomes After Cesarean Section—A Cross-Sectional Study From Rural Rwanda

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