Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, UNDP, UNFPA, UNICEF, WHO, World Bank Special Programme of Research, World Health Organization, Geneva, Switzerland.
BJOG. 2016 Apr;123(5):745-53. doi: 10.1111/1471-0528.13592. Epub 2015 Aug 24.
Caesarean section was initially performed to save the lives of the mother and/or her baby. Caesarean section rates have risen substantially worldwide over the past decades. In this study, we set out to compile all available caesarean section rates worldwide at the country level, and to identify the appropriate caesarean section rate at the population level associated with the minimal maternal and neonatal mortality.
Ecological study using longitudinal data.
Worldwide country-level data.
A total of 159 countries were included in the analyses, representing 98.0% of global live births (2005).
Nationally representative caesarean section rates from 2000 to 2012 were compiled. We assessed the relationship between caesarean section rates and mortality outcomes, adjusting for socio-economic development by means of human development index (HDI) using fractional polynomial regression models.
Maternal mortality ratio and neonatal mortality rate.
Most countries have experienced increases in caesarean section rate during the study period. In the unadjusted analysis, there was a negative association between caesarean section rates and mortality outcomes for low caesarean section rates, especially among the least developed countries. After adjusting for HDI, this effect was much smaller and was only observed below a caesarean section rate of 5-10%. No important association between the caesarean section rate and maternal and neonatal mortality was observed when the caesarean section rate exceeded 10%.
Although caesarean section is an effective intervention to save maternal and infant lives, based on the available ecological evidence, caesarean section rates higher than around 10% at the population level are not associated with decreases in maternal and neonatal mortality rates, and thus may not be necessary to achieve the lowest maternal and neonatal mortality.
The caesarean section rate of around 10% may be the optimal rate to achieve the lowest mortality.
剖宫产术最初是为了挽救母亲和/或婴儿的生命而进行的。在过去几十年中，全世界的剖宫产率大幅上升。在这项研究中，我们旨在汇编全球各国的所有可用剖宫产率，并确定与最低母婴死亡率相关的人口水平的适当剖宫产率。
使用纵向数据的生态研究。
全球各国数据。
共有 159 个国家的数据分析，占全球活产儿的 98.0%（2005 年）。
汇编了 2000 年至 2012 年全国代表性的剖宫产率。我们使用分数多项式回归模型，通过人类发展指数（HDI）调整社会经济发展，评估了剖宫产率与死亡率结局之间的关系。
孕产妇死亡率和新生儿死亡率。
在研究期间，大多数国家的剖宫产率都有所上升。在未调整分析中，剖宫产率与死亡率结局呈负相关，尤其是在最不发达国家中，剖宫产率较低。调整了 HDI 后，这种影响要小得多，仅在剖宫产率低于 5-10%时观察到。当剖宫产率超过 10%时，剖宫产率与母婴死亡率之间没有重要关联。
尽管剖宫产术是挽救母婴生命的有效干预措施，但根据现有的生态学证据，在人口水平上，剖宫产率高于 10%左右与降低母婴死亡率无关，因此可能没有必要达到最低的母婴死亡率。
剖宫产率约为 10%可能是实现最低死亡率的最佳率。
