title: Association between Maternal Mortality and Cesarean Section: Turkey Experience.
abstract: BACKGROUND
  To investigate the cesarean Section (C/S) rates and maternal mortality (MM) causes and its relation between 2002 and 2013.
  
  
  METHODS
  Data were gathered from Turkish Ministry of Health and Istanbul Health Administration. The Annual Clinical Reports for 2002-2013 were reviewed and analyzed: C/Ss and maternal deaths in women who gave birth ≥20 weeks between January 1, 2002, and December 31, 2013, in any hospital in Turkey and Istanbul.
  
  
  RESULTS
  The major causes of MM were hemorrhage (20%), hypertensive disorders (18.2%), embolism (10.3%), cardiovascular conditions (9%), infection (8.5%), and other causes (10.4%). Overall, the average annual CS delivery rate was 46.4% in Istanbul and 36.6% in Turkey. There was a significant increase in the CS rates in Istanbul and Turkey from 2008 to 2013 relative to those from 2002 to 2007 (p = 0.004). There was a statistically significant and inverse relationship (97.2%) between the MMR and CS rate from 2002 to 2013 in Turkey (p = 0.001). However, no significant relationship was detected between the MMR and CS rate from 2002 to 2013 in Istanbul (p > 0.05). There was a significant inverse correlation (66.3%) between the CS rate and peripartumhemorrhage in Turkey (p = 0.019) and there was a significant inverse correlation (66.5%) between the CS rate and peripartumhemorrhage(p = 0.018) in Istanbul between 2007 to 2013. There were no significant differences in ante-intrapartum haemorrhage bleeding (p > 0.05) or postpartum hemorrhage (p > 0.05) from 2007 to 2013.
  
  
  CONCLUSIONS
  This study demonstrates that there was a inverse correlation between increased CS and maternal mortality rates during the previous decade in Turkey. Although cesarean rates increase excessively, it appears that improved health care facilities have a positive effect on MMRs in Turkey.
authors.affiliation: Fatih Sultan Mehmet Training and Research Hospital Obstetrics and Gynecology Department, Fatih Sultan Mehmet Hastanesi E5 Karayolu Uzeri Icerenkoy Atasehir,34752, Istanbul, Turkey.
authors.forename: Cihangir
authors.initials: C
authors.lastname: Uzuncakmak
authors.affiliation: Istanbul Training and Research Hospital Obstetrics and Gynecology Department, Kasap Ilyas Mah. Org. Abdurrahman Nafiz Gurman Cd., 34098, Istanbul, Turkey.
authors.forename: Hasene
authors.initials: H
authors.lastname: Ozcam
mesh_terms: D000328:Adult; D002585:Cesarean Section; D004617:Embolism / Q000209:etiology / Q000401:mortality; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000401:mortality; D008428:Maternal Mortality; D006473:Postpartum Hemorrhage / Q000209:etiology / Q000401:mortality; D011247:Pregnancy; D012189:Retrospective Studies; D014421:Turkey