title: Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Pisake
authors.initials: P
authors.lastname: Lumbiganon
authors.forename: Malinee
authors.initials: M
authors.lastname: Laopaiboon
authors.forename: A Metin
authors.initials: AM
authors.lastname: Gülmezoglu
authors.forename: João Paulo
authors.initials: JP
authors.lastname: Souza
authors.forename: Surasak
authors.initials: S
authors.lastname: Taneepanichskul
authors.forename: Pang
authors.initials: P
authors.lastname: Ruyan
authors.forename: Deepika Eranjanie
authors.initials: DE
authors.lastname: Attygalle
authors.forename: Naveen
authors.initials: N
authors.lastname: Shrestha
authors.forename: Rintaro
authors.initials: R
authors.lastname: Mori
authors.forename: Duc Hinh
authors.initials: DH
authors.lastname: Nguyen
authors.forename: Thi Bang
authors.initials: TB
authors.lastname: Hoang
authors.forename: Tung
authors.initials: T
authors.lastname: Rathavy
authors.forename: Kang
authors.initials: K
authors.lastname: Chuyun
authors.forename: Kannitha
authors.initials: K
authors.lastname: Cheang
authors.forename: Mario
authors.initials: M
authors.lastname: Festin
authors.forename: Venus
authors.initials: V
authors.lastname: Udomprasertgul
authors.forename: Maria Julieta V
authors.initials: MJ
authors.lastname: Germar
authors.forename: Gao
authors.initials: G
authors.lastname: Yanqiu
authors.forename: Malabika
authors.initials: M
authors.lastname: Roy
authors.forename: Guillermo
authors.initials: G
authors.lastname: Carroli
authors.forename: Katherine
authors.initials: K
authors.lastname: Ba-Thike
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Filatova
authors.forename: José
authors.initials: J
authors.lastname: Villar
mesh_terms: 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