Relationship Between Cesarean Delivery Rate and Maternal and Neonatal Mortality

Molina, George; Weiser, Thomas; Lipsitz, Stuart R.; Esquivel, Micaela; Uribe-Leitz, Tarsicio; Azad, Tej D.; Shah, Neel; Semrau, Katherine; Berry, William R.; Gawande, Atul A.; Haynes, Alex B.

doi:10.1001/jama.2015.15553

Cited by 485 publications

(410 citation statements)

References 19 publications

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“…A recent study demonstrated that a national CS rate of up to approximately 19 per 100 live births is associated with lower maternalor neonatalmortalityamong WHO member states [22]. It can be assumed that the previously recommended national targetratesfor CS deliveries may be too low.…”

Section: Discussionmentioning

confidence: 99%

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Association between Maternal Mortality and Cesarean Section: Turkey Experience

Uzunçakmak

Özçam²

2016

PLoS ONE

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BackgroundTo investigate the cesarean Section (C/S) rates and maternal mortality (MM) causes and its relation between 2002 and 2013.MethodsData were gathered from Turkish Ministry of Health and Istanbul Health Administration. The Annual Clinical Reports for 2002–2013 were reviewed and analyzed: C/Ss and maternal deaths in women who gave birth ≥20 weeks between January 1, 2002, and December 31, 2013, in any hospital in Turkey and Istanbul.ResultsThe major causes of MM were hemorrhage (20%), hypertensive disorders (18.2%), embolism (10.3%), cardiovascular conditions (9%), infection (8.5%), and other causes (10.4%). Overall, the average annual CS delivery rate was 46.4% in Istanbul and 36.6% in Turkey. There was a significant increase in the CS rates in Istanbul and Turkey from 2008 to 2013 relative to those from 2002 to 2007 (p = 0.004). There was a statistically significant and inverse relationship (97.2%) between the MMR and CS rate from 2002 to 2013 in Turkey (p = 0.001). However, no significant relationship was detected between the MMR and CS rate from 2002 to 2013 in Istanbul (p > 0.05). There was a significant inverse correlation (66.3%) between the CS rate and peripartumhemorrhage in Turkey (p = 0.019) and there was a significant inverse correlation (66.5%) between the CS rate and peripartumhemorrhage(p = 0.018) in Istanbul between 2007 to 2013. There were no significant differences in ante-intrapartum haemorrhage bleeding (p > 0.05) or postpartum hemorrhage (p > 0.05) from 2007 to 2013.ConclusionsThis study demonstrates that there was a inverse correlation between increased CS and maternal mortality rates during the previous decade in Turkey. Although cesarean rates increase excessively, it appears that improved health care facilities have a positive effect on MMRs in Turkey.

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Section: Discussionmentioning

confidence: 99%

“…Higher CS delivery rates were not correlated with maternal or neonatal mortality at a country level in that study. A sensitivity analysis including only 76 countries demonstrated that delivery rates of >6.9 to 20.1 per 100 live births were inversely correlated with the MMR [22]. …”

Section: Discussionmentioning

confidence: 99%

Association between Maternal Mortality and Cesarean Section: Turkey Experience

Uzunçakmak

Özçam²

2016

PLoS ONE

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“…The rate of cesarean delivery has increased dramatically worldwide over the past several decades and now exceeds 55% of all deliveries in many countries 1. In the US, cesarean section frequency has surpassed 30% for nearly a decade,2,3 with a wide distribution that ranges from 7.1% to 69.9% across hospitals 4.…”

Section: Introductionmentioning

confidence: 99%

Vacuum-assisted cesarean section

McQuivey

Block

2017

IJWH

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There has been a dramatic rise in the frequency of cesarean sections, surpassing 30% of all deliveries in the US. This upsurge, coupled with a decreasing willingness to allow vaginal birth after cesarean section, has resulted in an expansion of the use of vacuum assistance to safely extract the fetal head. By avoiding the use of a delivering hand or forceps blade, the volume being delivered through the uterine incision can be decreased when the vacuum is used properly. Reducing uterine extensions with their associated complications (eg, excessive blood loss) in difficult cases is also a theoretical advantage of vacuum delivery. Maternal discomfort related to excessive fundal pressure may also be lessened. To minimize the risk of neonatal morbidity, proper cup placement over the “flexion point” remains essential to maintain vacuum integrity and reduce the chance of inadvertent detachment and uterine extensions. Based on the published literature and pragmatic clinical experience, utilization of the vacuum device is a safe and effective technique to assist delivery during cesarean section.

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“…Short-term complications include hemorrhage, pain, excessive use of pain medication, infection, damage to pelvic organs, and maternal mortality. Pelvic pain, emotional problems, and infertility are among the long-term complications of CS (5)(6)(7)(8)(9). The total rate of side effects after CS was estimated as 11.6% (10).…”

Section: Introductionmentioning

confidence: 99%