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The
Lancet 2006; 367:1819-1829
DOI:10.1016/S0140-6736(06)68704-7
Caesarean delivery rates and pregnancy outcomes:
the 2005 WHO global survey on maternal and perinatal health in Latin
America
José Villar  a  , Eliette Valladares b, Daniel Wojdyla c, Nelly Zavaleta d, Guillermo Carroli c, Alejandro Velazco e, Archana Shah a, Liana Campodónico c, Vicente Bataglia f, Anibal Faundes g, Ana Langer h, Alberto Narváez i, Allan Donner j, Mariana Romero k, Sofia Reynoso l, Karla Simônia de
Pádua g, Daniel Giordano c, Marius Kublickas m and
Arnaldo Acosta n, for
the WHO 2005 global survey on maternal and perinatal health research
group
Summary
Background
Caesarean delivery rates continue
to increase worldwide. Our aim was to assess the association between
caesarean delivery and pregnancy outcome at the institutional level,
adjusting for the pregnant population and institutional
characteristics.
Methods
For the 2005 WHO global survey on
maternal and perinatal health, we assessed a multistage stratified sample,
comprising 24 geographic regions in eight countries in Latin America. We
obtained individual data for all women admitted for delivery over 3 months
to 120 institutions randomly selected from of 410 identified institutions.
We also obtained institutional-level data.
Findings
We obtained data for 97 095 of
106 546 deliveries (91% coverage). The median rate of caesarean delivery
was 33% (quartile range 2443), with the highest rates of caesarean
delivery noted in private hospitals (51%, 4357). Institution-specific
rates of caesarean delivery were affected by primiparity, previous
caesarean delivery, and institutional complexity. Rate of caesarean
delivery was positively associated with postpartum antibiotic treatment
and severe maternal morbidity and mortality, even after adjustment for
risk factors. Increase in the rate of caesarean delivery was associated
with an increase in fetal mortality rates and higher numbers of babies
admitted to intensive care for 7 days or longer even after adjustment for
preterm delivery. Rates of preterm delivery and neonatal mortality both
rose at rates of caesarean delivery of between 10% and 20%.
Interpretation
High rates of caesarean delivery
do not necessarily indicate better perinatal care and can be associated
with harm.
Affiliations
a. UNDP/UNFPA/WHO/World Bank Special
Programme of Research, Development and Research Training in Human
Reproduction, Department of Reproductive Health and Research, WHO, 1211
Geneva 27, Switzerland
b. Universidad Nacional Autónoma de
Nicaragua, León, Nicaragua
c. Centro Rosarino de Estudios
Perinatales, Rosario, Argentina
d. Instituto de Investigación
Nutricional, Lima, Peru
e. Hospital Docente Ginecobstétrico
América Arias, La Habana, Cuba
f. Department of Obstetrics and
Gynecology, Hospital Nacional de Itauguá, Paraguay, Asunción,
Paraguay
g. Centro de
Pesquisas em Saúde Reprodutiva de Campinas, Campinas, SP,
Brazil
h. EngenderHealth, New York, NY,
USA
i. Fundación Salud, Ambiente y
Desarrollo, Quito, Ecuador
j. Department of Epidemiology and
Biostatistics, Schulich School of Medicine and Dentistry, University of
Western Ontario, London, Ontario Canada
k. CONICET/Centro de Estudios de Estado
y Sociedad, Buenos Aires, Argentina
l. The Population Council, Latin America
Office, Mexico City, Mexico
m. Karolinska Institutet, Stockholm,
Sweden
n. Department of Obstetrics and
Gynaecology, Universidad Nacional de Asunción, Paraguay, Asunción,
Paraguay
Correspondence to: Dr José
Villar |
