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Summary
Background Caesarean section prevalence is increasing in Asia and Latin America while remaining low in most
African regions. Caesarean section delivery is effective for saving maternal and infant lives when they are provided for
medically-indicated reasons. On the basis of ecological studies, caesarean delivery prevalence between 9% and
19% has been associated with better maternal and perinatal outcomes, such as reduced maternal land fetal mortality.
However, the specific prevalence of obstetric and medical complications that require caesarean section have not been
established, especially in low-income and middle-income countries (LMICs). We sought to provide information to
inform the approach to the provision of caesarean section in low-resource settings.
Methods We did a literature review to establish the prevalence of obstetric and medical conditions for six potentially
life-saving indications for which caesarean section could reduce mortality in LMICs. We then analysed a large,
prospective population-based dataset from six LMICs (Argentina, Guatemala, Kenya, India, Pakistan, and Zambia) to
determine the prevalence of caesarean section by indication for each site. We considered that an acceptable number
of events would be between the 25th and 75th percentile of those found in the literature.
Findings Between Jan 1, 2010, and Dec 31, 2013, we enrolled a total of 271 855 deliveries in six LMICs (seven research
sites). Caesarean section prevalence ranged from 35% (3467 of 9813 deliveries in Argentina) to 1%
(303 of 16 764 deliveries in Zambia). Argentina’s and Guatemala’s sites all met the minimum 25th percentile for five
of six indications, whereas sites in Zambia and Kenya did not reach the minimum prevalence for caesarean section
for any of the indications. Across all sites, a minimum overall caesarean section of 9% was needed to meet the
prevalence of the six indications in the population studied.
Interpretation In the site with high caesarean section prevalence, more than half of the procedures were not done for
life-saving conditions, whereas the sites with low proportions of caesarean section (below 9%) had an insufficient
number of caesarean procedures to cover those life-threatening causes. Attempts to establish a minimum caesarean
prevalence should go together with focusing on the life-threatening causes for the mother and child. Simple methods
should be developed to allow timely detection of life-threatening conditions, to explore actions that can remedy those
conditions, and the timely transfeSummary
Background Caesarean section prevalence is increasing in Asia and Latin America while remaining low in most
African regions. Caesarean section delivery is effective for saving maternal and infant lives when they are provided for
medically-indicated reasons. On the basis of ecological studies, caesarean delivery prevalence between 9% and
19% has been associated with better maternal and perinatal outcomes, such as reduced maternal land fetal mortality.
However, the specific prevalence of obstetric and medical complications that require caesarean section have not been
established, especially in low-income and middle-income countries (LMICs). We sought to provide information to
inform the approach to the provision of caesarean section in low-resource settings.
Methods We did a literature review to establish the prevalence of obstetric and medical conditions for six potentially
life-saving indications for which caesarean section could reduce mortality in LMICs. We then analysed a large,
prospective population-based dataset from six LMICs (Argentina, Guatemala, Kenya, India, Pakistan, and Zambia) to
determine the prevalence of caesarean section by indication for each site. We considered that an acceptable number
of events would be between the 25th and 75th percentile of those found in the literature.
Findings Between Jan 1, 2010, and Dec 31, 2013, we enrolled a total of 271 855 deliveries in six LMICs (seven research
sites). Caesarean section prevalence ranged from 35% (3467 of 9813 deliveries in Argentina) to 1%
(303 of 16 764 deliveries in Zambia). Argentina’s and Guatemala’s sites all met the minimum 25th percentile for five
of six indications, whereas sites in Zambia and Kenya did not reach the minimum prevalence for caesarean section
for any of the indications. Across all sites, a minimum overall caesarean section of 9% was needed to meet the
prevalence of the six indications in the population studied.
Interpretation In the site with high caesarean section prevalence, more than half of the procedures were not done for
life-saving conditions, whereas the sites with low proportions of caesarean section (below 9%) had an insufficient
number of caesarean procedures to cover those life-threatening causes. Attempts to establish a minimum caesarean
prevalence should go together with focusing on the life-threatening causes for the mother and child. Simple methods
should be developed to allow timely detection of life-threatening conditions, to explore actions that can remedy those
conditions, and the timely transfer of women with those conditions to health centres that could provide adequate care
for those conditions.r of women with those conditions to health centres that could provide adequate care
for those conditions. |
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