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Global study highlights C-section death rates

Friday March 29th, 2019

Death rates from caesarean sections are disproportionately high in low and middle-income countries (LMIC), according to the largest study to date on risks following C-sections, published today.

The study, which was led by Queen Mary, University of London, UK, and is published in The Lancet, analysed data from 12 million pregnancies and found that women in sub-Saharan Africa are 100 times more likely to die following a C-section than a woman in the UK.

First author Dr Soha Sobhy from Queen Mary University of London said the outcomes for women in LMICs were “far worse than we expected”.

Lead author Professor Shakila Thangaratinam from Queen Mary University of London added: “Caesarean sections are the most commonly performed operation worldwide. They are meant to be life saving for both mother and baby, but because of many factors, such as poor access, late referrals, inappropriate procedures, poor resources and training, this is not always the case.

“Now that we know the risk factors and countries associated with poor outcomes, we can make a more targeted effort to improve conditions for mothers globally, so that timely and safe caesarean sections can be done wherever they are needed.”

Every year 300,000 women die during childbirth, 99% of whom are from LMICs. This study looked at data from 196 studies from 67 LMICs, covering 12 million pregnancies, and found that the risk of death from C-sections in LMICs was 7.6 per 1,000 procedures, with highest burden in sub-Saharan Africa at 10.9 per 1,000. In the UK, the figure is eight per 100,000.

Stillbirth rates following caesarean were also concerning: 56.6 per 1,000, with the highest rates in sub-Saharan Africa at 82.5 per 1,000, while the perinatal death rate was 84.7 per 1,000 caesarean sections. The worst regions were the Middle East and North Africa, where the rate was 354.6 per 1,000.

The study also discovered that one quarter of all women in LMICs who died while giving birth had undergone caesarean section, while women undergoing emergency caesarean section in LMICs were twice more likely to die than those delivering by elective caesarean section.

The research team called for specific training to reduce postpartum haemorrhage, which was found to be the commonest cause of maternal death following caesarean section. It also said policy makers and healthcare professionals must improve access to surgery, promote appropriate use of the procedure, provide safe surgical environments, and increase neonatal resuscitation to help improve outcomes to babies.

It also highlighted the need for training in labour management to reduce inappropriate caesarean sections, and to promote a reduction in caesarean sections performed in the second stage of labour, which are the riskiest.

Sobhy S, Arroyo-Manzano D, Murugesu N et al. Maternal and perinatal mortality and complications associated with caesarean section in low and middle-income countries: A systematic review and meta-analysis of 12 million pregnancies. Lancet 29 March 2019; doi: 10.1016/S0140-6736(18)32386-9

Tags: Africa | Childbirth and Pregnancy | UK News | Women's Health & Gynaecology | World Health

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