title: Maternal and fetal mortality and complications associated with cesarean section deliveries in teaching hospitals in Asia.
abstract: 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.
authors.affiliation: Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand. cvirasak@medicine.psu.ac.th
authors.forename: Virasakdi
authors.initials: V
authors.lastname: Chongsuvivatwong
authors.forename: Hafni
authors.initials: H
authors.lastname: Bachtiar
authors.forename: Mahbub Elahi
authors.initials: ME
authors.lastname: Chowdhury
authors.forename: Sunil
authors.initials: S
authors.lastname: Fernando
authors.forename: Chitkasaem
authors.initials: C
authors.lastname: Suwanrath
authors.forename: Ounjai
authors.initials: O
authors.lastname: Kor-Anantakul
authors.forename: Le Anh
authors.initials: le A
authors.lastname: Tuan
authors.forename: Apiradee
authors.initials: A
authors.lastname: Lim
authors.forename: Pisake
authors.initials: P
authors.lastname: Lumbiganon
authors.forename: Bekha
authors.initials: B
authors.lastname: Manandhar
authors.forename: Masrul
authors.initials: M
authors.lastname: Muchtar
authors.forename: Lutfan
authors.initials: L
authors.lastname: Nahar
authors.forename: Nguyen Trong
authors.initials: NT
authors.lastname: Hieu
authors.forename: Pan Xiao
authors.initials: PX
authors.lastname: Fang
authors.forename: Witoon
authors.initials: W
authors.lastname: Prasertcharoensuk
authors.forename: Erdenetungalag
authors.initials: E
authors.lastname: Radnaabarzar
authors.forename: Daulat
authors.initials: D
authors.lastname: Sibuea
authors.forename: Kyu Kyu
authors.initials: KK
authors.lastname: Than
authors.forename: Piangjit
authors.initials: P
authors.lastname: Tharnpaisan
authors.forename: Tran Son
authors.initials: TS
authors.lastname: Thach
authors.forename: Patrick
authors.initials: P
authors.lastname: Rowe
mesh_terms: 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