Maternal and fetal mortality and complications associated with cesarean section deliveries in teaching hospitals in Asia.
OBJECTIVE
To compare the mortality, morbidity of emergency and elective cesarean section with vaginal delivery among Asian teaching hospitals.


METHODS
Hospital based prospective study at 12 centers of 9 countries.


RESULTS
12 591 vaginal deliveries, 3062 elective and 4328 emergency cesarean section were followed up to 5 days postpartum. Maternal deaths (95% CI) per 1000 births among vaginal deliveries being 0.47 (0.17, 1.03) was not significantly different from 0.31 (0.01, 1.73) of elective cesarean section and both rates were significantly lower than 2.87 (1.53, 4.91) per 1000 births of emergency section. The vaginal delivery group had significantly lower incidences of all major complication except significantly higher chance of secondary operations and non-significantly different risk for endometritis. Corresponding neonatal mortality per 1000 deliveries among the three groups were 7 (5.6, 8.6), 2.2 (0.9, 4.6) and 12.4 (9.3, 16.2) (P < 0.001). Vaginal delivery also had higher rates of severe asphyxia and palsy than elective cesarean section.


CONCLUSIONS
Maternal complications were increased by cesarean delivery but elective section may reduce neonatal complication.
Chongsuvivatwong
Virasakdi
V
Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand. cvirasak@medicine.psu.ac.th
Bachtiar
Hafni
H
Chowdhury
Mahbub Elahi
ME
Fernando
Sunil
S
Suwanrath
Chitkasaem
C
Kor-Anantakul
Ounjai
O
Tuan
Le Anh
le A
Lim
Apiradee
A
Lumbiganon
Pisake
P
Manandhar
Bekha
B
Muchtar
Masrul
M
Nahar
Lutfan
L
Hieu
Nguyen Trong
NT
Fang
Pan Xiao
PX
Prasertcharoensuk
Witoon
W
Radnaabarzar
Erdenetungalag
E
Sibuea
Daulat
D
Than
Kyu Kyu
KK
Tharnpaisan
Piangjit
P
Thach
Tran Son
TS
Rowe
Patrick
P
D000293:Adolescent; D000328:Adult; D001208:Asia / Q000453:epidemiology; D002585:Cesarean Section / Q000401:mortality*; D005260:Female; D046689:Fetal Mortality; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008428:Maternal Mortality; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000401:mortality*; D054238:Perinatal Mortality; D011247:Pregnancy; D011446:Prospective Studies; D055815:Young Adult