UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland.
BMC Med. 2010 Nov 10;8:71. doi: 10.1186/1741-7015-8-71.
There is worldwide debate about the appropriateness of caesarean sections performed without medical indications. In this analysis, we aim to further investigate the relationship between caesarean section without medical indication and severe maternal outcomes.
This is a multicountry, facility-based survey that used a stratified multistage cluster sampling design to obtain a sample of countries and health institutions worldwide. A total of 24 countries and 373 health facilities participated in this study. Data collection took place during 2004 and 2005 in Africa and the Americas and during 2007 and 2008 in Asia. All women giving birth at the facility during the study period were included and had their medical records reviewed before discharge from the hospital. Univariate and multilevel analysis were performed to study the association between each group's mode of delivery and the severe maternal and perinatal outcome.
A total of 286,565 deliveries were analysed. The overall caesarean section rate was 25.7% and a total of 1.0 percent of all deliveries were caesarean sections without medical indications, either due to maternal request or in the absence of other recorded indications. Compared to spontaneous vaginal delivery, all other modes of delivery presented an association with the increased risk of death, admission to ICU, blood transfusion and hysterectomy, including antepartum caesarean section without medical indications (Adjusted Odds Ratio (Adj OR), 5.93, 95% Confidence Interval (95% CI), 3.88 to 9.05) and intrapartum caesarean section without medical indications (Adj OR, 14.29, 95% CI, 10.91 to 18.72). In addition, this association is stronger in Africa, compared to Asia and Latin America.
Caesarean sections were associated with an intrinsic risk of increased severe maternal outcomes. We conclude that caesarean sections should be performed when a clear benefit is anticipated, a benefit that might compensate for the higher costs and additional risks associated with this operation.
全世界都在讨论没有医学指征的剖宫产是否恰当。在此分析中，我们旨在进一步研究无医学指征剖宫产与严重产妇结局之间的关系。
这是一项多国家、基于机构的调查，采用分层多阶段聚类抽样设计，在全球范围内抽取国家和医疗机构样本。共有 24 个国家和 373 个医疗机构参与了这项研究。数据收集于 2004 年至 2005 年在非洲和美洲进行，于 2007 年至 2008 年在亚洲进行。在研究期间，所有在医疗机构分娩的妇女都被纳入，并在出院前对其病历进行了审查。采用单变量和多水平分析来研究每个组别的分娩方式与严重产妇和围产儿结局之间的关联。
共分析了 286565 例分娩。总剖宫产率为 25.7%，其中 1.0%的分娩为无医学指征的剖宫产，或因产妇要求，或因无其他记录的指征。与自然阴道分娩相比，所有其他分娩方式都与死亡、入住 ICU、输血和子宫切除的风险增加相关，包括无医学指征的产前剖宫产（调整后的优势比（Adj OR）为 5.93，95%置信区间（95%CI）为 3.88 至 9.05）和无医学指征的产时剖宫产（Adj OR 为 14.29，95%CI 为 10.91 至 18.72）。此外，与亚洲和拉丁美洲相比，这种关联在非洲更强。
剖宫产与增加严重产妇结局的内在风险相关。我们的结论是，只有当预期有明确的益处时，才应进行剖宫产，这种益处可能会弥补与该手术相关的更高成本和额外风险。
