Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08.
BACKGROUND
There has been concern about rising rates of caesarean section worldwide. This Article reports the third phase of the WHO global survey, which aimed to estimate the rate of different methods of delivery and to examine the relation between method of delivery and maternal and perinatal outcomes in selected facilities in Africa and Latin America in 2004-05, and in Asia in 2007-08.


METHODS
Nine countries participated in the Asia global survey: Cambodia, China, India, Japan, Nepal, Philippines, Sri Lanka, Thailand, and Vietnam. In each country, the capital city and two other regions or provinces were randomly selected. We studied all women admitted for delivery during 3 months in institutions with 6000 or fewer expected deliveries per year and during 2 months in those with more than 6000 deliveries. We gathered data for institutions to obtain a detailed description of the health facility and its resources for obstetric care. We obtained data from women's medical records to summarise obstetric and perinatal events.


RESULTS
We obtained data for 109 101 of 112 152 deliveries reported in 122 recruited facilities (97% coverage), and analysed 107 950 deliveries. The overall rate of caesarean section was 27.3% (n=29 428) and of operative vaginal delivery was 3.2% (n=3465). Risk of maternal mortality and morbidity index (at least one of: maternal mortality, admission to intensive care unit [ICU], blood transfusion, hysterectomy, or internal iliac artery ligation) was increased for operative vaginal delivery (adjusted odds ratio 2.1, 95% CI 1.7-2.6) and all types of caesarean section (antepartum without indication 2.7, 1.4-5.5; antepartum with indication 10.6, 9.3-12.0; intrapartum without indication 14.2, 9.8-20.7; intrapartum with indication 14.5, 13.2-16.0). For breech presentation, caesarean section, either antepartum (0.2, 0.1-0.3) or intrapartum (0.3, 0.2-0.4), was associated with improved perinatal outcomes, but also with increased risk of stay in neonatal ICU (2.0, 1.1-3.6; and 2.1, 1.2-3.7, respectively).


CONCLUSIONS
To improve maternal and perinatal outcomes, caesarean section should be done only when there is a medical indication.


BACKGROUND
US Agency for International Development (USAID); UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Switzerland; Ministry of Health, Labour and Welfare of Japan; Ministry of Public Health, China; and Indian Council of Medical Research.
Lumbiganon
Pisake
P
Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Laopaiboon
Malinee
M
Gülmezoglu
A Metin
AM
Souza
João Paulo
JP
Taneepanichskul
Surasak
S
Ruyan
Pang
P
Attygalle
Deepika Eranjanie
DE
Shrestha
Naveen
N
Mori
Rintaro
R
Nguyen
Duc Hinh
DH
Hoang
Thi Bang
TB
Rathavy
Tung
T
Chuyun
Kang
K
Cheang
Kannitha
K
Festin
Mario
M
Udomprasertgul
Venus
V
Germar
Maria Julieta V
MJ
Yanqiu
Gao
G
Roy
Malabika
M
Carroli
Guillermo
G
Ba-Thike
Katherine
K
Filatova
Ekaterina
E
Villar
José
J
D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data*; D016000:Cluster Analysis; D036861:Delivery, Obstetric / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006306:Health Surveys; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008428:Maternal Mortality; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012307:Risk Factors; D014944:World Health Organization; D055815:Young Adult