title: Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study.
abstract: OBJECTIVE
  To assess the risks and benefits associated with caesarean delivery compared with vaginal delivery.
  
  
  METHODS
  Prospective cohort study within the 2005 WHO global survey on maternal and perinatal health.
  
  
  METHODS
  410 health facilities in 24 areas in eight randomly selected Latin American countries; 123 were randomly selected and 120 participated and provided data
  
  
  METHODS
  106,546 deliveries reported during the three month study period, with data available for 97,095 (91% coverage).
  
  
  METHODS
  Maternal, fetal, and neonatal morbidity and mortality associated with intrapartum or elective caesarean delivery, adjusted for clinical, demographic, pregnancy, and institutional characteristics.
  
  
  RESULTS
  Women undergoing caesarean delivery had an increased risk of severe maternal morbidity compared with women undergoing vaginal delivery (odds ratio 2.0 (95% confidence interval 1.6 to 2.5) for intrapartum caesarean and 2.3 (1.7 to 3.1) for elective caesarean). The risk of antibiotic treatment after delivery for women having either type of caesarean was five times that of women having vaginal deliveries. With cephalic presentation, there was a trend towards a reduced odds ratio for fetal death with elective caesarean, after adjustment for possible confounding variables and gestational age (0.7, 0.4 to 1.0). With breech presentation, caesarean delivery had a large protective effect for fetal death. With cephalic presentation, however, independent of possible confounding variables and gestational age, intrapartum and elective caesarean increased the risk for a stay of seven or more days in neonatal intensive care (2.1 (1.8 to 2.6) and 1.9 (1.6 to 2.3), respectively) and the risk of neonatal mortality up to hospital discharge (1.7 (1.3 to 2.2) and 1.9 (1.5 to 2.6), respectively), which remained higher even after exclusion of all caesarean deliveries for fetal distress. Such increased risk was not seen for breech presentation. Lack of labour was a risk factor for a stay of seven or more days in neonatal intensive care and neonatal mortality up to hospital discharge for babies delivered by elective caesarean delivery, but rupturing of membranes may be protective.
  
  
  CONCLUSIONS
  Caesarean delivery independently reduces overall risk in breech presentations and risk of intrapartum fetal death in cephalic presentations but increases the risk of severe maternal and neonatal morbidity and mortality in cephalic presentations.
authors.affiliation: Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford OX3 9DU. jose.villar@obs-gyn.ox.ac.uk
authors.forename: José
authors.initials: J
authors.lastname: Villar
authors.forename: Guillermo
authors.initials: G
authors.lastname: Carroli
authors.forename: Nelly
authors.initials: N
authors.lastname: Zavaleta
authors.forename: Allan
authors.initials: A
authors.lastname: Donner
authors.forename: Daniel
authors.initials: D
authors.lastname: Wojdyla
authors.forename: Anibal
authors.initials: A
authors.lastname: Faundes
authors.forename: Alejandro
authors.initials: A
authors.lastname: Velazco
authors.forename: Vicente
authors.initials: V
authors.lastname: Bataglia
authors.forename: Ana
authors.initials: A
authors.lastname: Langer
authors.forename: Alberto
authors.initials: A
authors.lastname: Narváez
authors.forename: Eliette
authors.initials: E
authors.lastname: Valladares
authors.forename: Archana
authors.initials: A
authors.lastname: Shah
authors.forename: Liana
authors.initials: L
authors.lastname: Campodónico
authors.forename: Mariana
authors.initials: M
authors.lastname: Romero
authors.forename: Sofia
authors.initials: S
authors.lastname: Reynoso
authors.forename: Karla Simônia
authors.initials: KS
authors.lastname: de Pádua
authors.forename: Daniel
authors.initials: D
authors.lastname: Giordano
authors.forename: Marius
authors.initials: M
authors.lastname: Kublickas
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Acosta
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data*; D002755:Choice Behavior; D005260:Female; D005313:Fetal Death / Q000209:etiology; D006276:Health Facility Size; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007902:Length of Stay; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors