Caesarean section in four South East Asian countries: reasons for, rates, associated care practices and health outcomes.
BACKGROUND
Caesarean section is a commonly performed operation on women that is globally increasing in prevalence each year. There is a large variation in the rates of caesarean, both in high and low income countries, as well as between different institutions within these countries. This audit aimed to report rates and reasons for caesarean and associated clinical care practices amongst nine hospitals in the four South East Asian countries participating in the South East Asia-Optimising Reproductive and Child Health in Developing countries (SEA-ORCHID) project.


METHODS
Data on caesarean rates, care practices and health outcomes were collected from the medical records of the 9550 women and their 9665 infants admitted to the nine participating hospitals across South East Asia between January and December 2005.


RESULTS
Overall 27% of women had a caesarean section, with rates varying from 19% to 35% between countries and 12% to 39% between hospitals within countries. The most common indications for caesarean were previous caesarean (7.0%), cephalopelvic disproportion (6.3%), malpresentation (4.7%) and fetal distress (3.3%). Neonatal resuscitation rates ranged from 7% to 60% between countries. Prophylactic antibiotics were almost universally given but variations in timing occurred between countries and between hospitals within countries.


CONCLUSIONS
Rates and reasons for caesarean section and associated clinical care practices and health outcomes varied widely between the four South East Asian countries.
Department of Obstetrics and Gynecology, College of Medicine, University of the Philippines Manila, Manila 1000, Philippines. mfestinmd@yahoo.com
Mario R
MR
Festin
Malinee
M
Laopaiboon
Porjai
P
Pattanittum
Melissa R
MR
Ewens
David J
DJ
Henderson-Smart
Caroline A
CA
Crowther
D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D001210:Asia, Southeastern; D016063:Blood Loss, Surgical; D002585:Cesarean Section / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D007231:Infant, Newborn; D008485:Medical Audit; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D011181:Postnatal Care; D011247:Pregnancy; D011256:Pregnancy Outcome