Background
Methods
Study design
Data collection
Statistical analysis
Results
Vaginal Delivery | Caesarean section without indications | Caesarean section with indications | Total deliveries | Total facilities | ||||
---|---|---|---|---|---|---|---|---|
Spontaneous | Operative | Antepartum | Intrapartum | Antepartum | Intrapartum | |||
% | % | % | % | % | % | n | n | |
Africa
| ||||||||
Algeria
| 80.5 | 5.9 | 0.04 | 0.1 | 5.9 | 7.5 | 15,578 | 18 |
Angola
| 97.7 | 0.8 | 0.1 | 0.02 | 1.0 | 0.5 | 6,322 | 20 |
D.R. Congo
| 84.8 | 2.3 | 0.1 | 0.1 | 1.4 | 11.4 | 8,804 | 21 |
Kenya
| 82.9 | 1.5 | 0.1 | 0.5 | 3.2 | 11.8 | 19,968 | 20 |
Niger
| 91.5 | 3.2 | 0.02 | 0.2 | 0.4 | 4.8 | 8,275 | 11 |
Nigeria
| 81.1 | 4.4 | 0.1 | 0.3 | 3.6 | 10.5 | 8,939 | 21 |
Uganda
| 85.4 | 1.2 | 0.1 | 0.3 | 2.1 | 10.9 | 13,836 | 20 |
Americas
| ||||||||
Argentina
| 62.1 | 2.8 | 0.2 | 0.1 | 17.8 | 17.0 | 10,689 | 14 |
Brazil
| 68.5 | 2.0 | 0.3 | 0.2 | 15.4 | 13.6 | 15,129 | 19 |
Cuba
| 61.7 | 2.7 | 0.02 | 0.1 | 16.6 | 18.8 | 12,642 | 17 |
Ecuador
| 59.2 | 0.5 | 0.1 | 0.6 | 7.8 | 31.8 | 12,414 | 18 |
Mexico
| 60.4 | 1.9 | 0.1 | 0.1 | 15.8 | 21.8 | 20,883 | 21 |
Nicaragua
| 69.1 | 0.1 | 0.1 | 0.2 | 7.7 | 22.8 | 5,636 | 8 |
Paraguay
| 57.3 | 0.8 | 1.2 | 0.9 | 18.1 | 21.7 | 3,460 | 17 |
Peru
| 65.4 | 0.6 | 0.01 | 0.0 | 13.2 | 20.8 | 16,040 | 17 |
Asia
| ||||||||
Cambodia
| 77.6 | 7.7 | 0.04 | 0.2 | 2.6 | 11.8 | 5,565 | 5 |
China
| 52.6 | 1.2 | 9.3 | 2.3 | 19.7 | 14.9 | 14,541 | 21 |
India
| 79.4 | 2.9 | 0.1 | 0.2 | 3.6 | 13.8 | 24,682 | 20 |
Japan
| 74.1 | 6.1 | 0.1 | 0.0 | 13.9 | 5.9 | 3,300 | 10 |
Nepal
| 76.0 | 3.8 | 0.04 | 0.1 | 6.2 | 14.0 | 8,489 | 8 |
Philippines
| 78.4 | 2.8 | 0.04 | 0.1 | 8.0 | 10.3 | 13,295 | 6 |
Sri Lanka
| 65.9 | 3.5 | 0.5 | 0.2 | 20.2 | 9.8 | 15,024 | 14 |
Thailand
| 61.6 | 4.3 | 0.3 | 0.1 | 13.4 | 20.2 | 9,745 | 12 |
Vietnam
| 62.2 | 2.2 | 0.2 | 0.8 | 4.3 | 30.2 | 13,309 | 15 |
Total
| 71.7 | 2.6 | 0.6 | 0.3 | 9.4 | 15.4 | 286,565 | 373 |
Vaginal delivery | Caesarean section without indications | Caesarean section with indications | Total | ||||
---|---|---|---|---|---|---|---|
Spontaneous | Operative | Antepartum | Intrapartum | Antepartum | Intrapartum | ||
N = 205,551 | N = 7,296 | N = 1,735 | N = 950 | N = 27,011 | N = 44,022 | N = 286,565 | |
Marital status (single) | 13.5 | 9.3 | 2.7 | 6.0 | 11.8 | 10.7 | 12.7 |
Maternal age | |||||||
≤16 years | 2.5 | 2 | 0.1 | 1.9 | 1.4 | 2.4 | 2.3 |
16 to 35 | 87.8 | 85.7 | 89.4 | 85.9 | 80.1 | 86 | 86.8 |
≥35 | 9.7 | 12.3 | 10.6 | 12.3 | 18.5 | 11.6 | 10.9 |
Years of education | |||||||
<7 | 30.9 | 28.4 | 11.4 | 20.5 | 18.4 | 24.7 | 28.6 |
7 to 12 | 57.1 | 54.9 | 59.0 | 56.1 | 59.4 | 57.6 | 57.4 |
>12 | 12 | 16.7 | 29.7 | 23.4 | 22.2 | 17.7 | 14.1 |
Primiparous | 41.2 | 57.3 | 73.3 | 58.8 | 37.6 | 49.7 | 42.8 |
Previous pregnancy
| |||||||
Low birth weight | 10.0 | 14.1 | 3.1 | 5.4 | 14.9 | 10.1 | 10.5 |
Fetal or neonatal death | 2.0 | 2.4 | 1.6 | 3.6 | 2.6 | 2.6 | 2.1 |
Caesarean delivery in the last pregnancy | 2 | 5.9 | 6.7 | 11.9 | 39.3 | 23.5 | 9 |
Current pregnancy
| |||||||
Induced labour | 9.9 | 15.4 | 0.0 | 13.9 | 0.0 | 13.9 | 9.7 |
Prelabour rupture of membranes | 9.4 | 13.2 | 8.4 | 16.0 | 8.7 | 15.3 | 10.3 |
Pregnancy induced hypertension | 2.8 | 5.3 | 2.9 | 3.2 | 8.5 | 5.5 | 3.8 |
Pre-eclampsia | 1.6 | 3.2 | 1.3 | 1.3 | 8.9 | 4.8 | 2.8 |
Eclampsia | 0.2 | 0.8 | 0.1 | 0.3 | 1 | 0.6 | 0.4 |
Chronic hypertension | 0.6 | 1 | 0.2 | 0.2 | 2.4 | 1.2 | 0.8 |
Vaginal bleeding in second half of pregnancy | 0.9 | 1.2 | 0.6 | 0.9 | 3.6 | 2 | 1.3 |
Suspected fetal growth impairment | 0.8 | 1 | 0.3 | 0.7 | 2.5 | 1 | 1 |
Breech or other non-cephalic presentation | 1 | 25.1 | 0 | 0 | 14.7 | 12.6 | 4.7 |
Referred for complication related to pregnancy | 18.8 | 23.9 | 9.1 | 14.2 | 34 | 28.8 | 21.8 |
HIV | 0.8 | 0.5 | 0.5 | 1.4 | 1 | 0.9 | 0.8 |
Cardiac/Renal diseases | 0.3 | 1 | 0.5 | 0.5 | 1.1 | 0.5 | 0.5 |
Chronic respiratory conditions | 0.5 | 0.7 | 0.3 | 0.2 | 1 | 0.6 | 0.6 |
Diabetes mellitus | 0.4 | 0.7 | 1.5 | 0.3 | 2.6 | 1 | 0.7 |
Malaria | 3.3 | 2.7 | 0.2 | 1.3 | 0.4 | 1.1 | 2.6 |
Sickle cell anaemia | 0.3 | 0.1 | 0.0 | 0.3 | 0.5 | 0.4 | 0.3 |
Severe anaemia | 0.5 | 0.8 | 0.1 | 0.5 | 0.8 | 0.5 | 0.6 |
Pyelonephritis or urinary infection | 5.9 | 4.4 | 0.6 | 5.4 | 8.4 | 8.6 | 6.5 |
Other medical conditions | 5.3 | 5.3 | 10.2 | 5.7 | 12.6 | 8.2 | 6.5 |
Maternal outcomes | n/N (%) | Adjusted OR [95%CI] |
---|---|---|
Death* | ||
Spontaneous (reference) | 196/205,551 (0.10) | 1 |
Operative | 34/7,296 (0.47) | 2.9 (1.84 to 4.56) |
Antepartum without indications |
0/1,735(0)
| Not estimated |
Intrapartum without indications |
2/950(0.21)
| 3.21 (0.78 to 13.2) |
Antepartum with indications |
36/27,011(0.13)
| 1.51 (0.97 to 2.33) |
Intrapartum with indications |
74/44,022(0.17)
| 1.7 (1.24 to 2.33) |
Admission to ICU**
| ||
Spontaneous (reference) | 1,189/205,551 (0.58) | 1 |
Operative | 172/7,296 (2.36) | 2.27 (1.89 to 2.73) |
Antepartum without indications |
22/1,735(1.27)
| 30.75 (18.12 to 52.17) |
Intrapartum without indications |
67/950(7.05)
| 58.85 (41.46 to 83.52) |
Antepartum with indications |
1,741/27,011(6.45)
| 63.4 (56.32 to 71.36) |
Intrapartum with indications |
3,457/44,022(7.85)
| 51.3 (46.56 to 56.59) |
Blood transfusion
†
| ||
Spontaneous (reference) | 1,940/205,303 (0.94) | 1 |
Operative | 198/7,287 (2.72) | 2.11 (1.79 to 2.48) |
Antepartum without indications |
9/1,735(0.52)
| 1.79 (0.91 to 3.52) |
Intrapartum without indications |
18/950(1.89)
| 3.7 (2.24 to 6.1) |
Antepartum with indications |
892/26,967(3.31)
| 3.75 (3.39 to 4.14) |
Intrapartum with indications |
1,475/43,928(3.36)
| 3.85 (3.55 to 4.16) |
Hysterectomy
††
| ||
Spontaneous (reference) | 82/205,299 (0.04) | 1 |
Operative | 11/7,278 (0.15) | 3.38 (1.73 to 6.59) |
Antepartum without indications |
0/1,733(0)
| Not estimated |
Intrapartum without indications |
4/949(0.42)
| 13.53 (4.79 to 38.2) |
Antepartum with indications |
100/26,916(0.37)
| 6.11 (4.38 to 8.52) |
Intrapartum with indications |
118/43,889(0.27)
| 6.68 (4.91 to -9.09) |
Severe Maternal Outcomes
†††
| ||
Spontaneous (reference) | 3,147/205,551 (1.53) | 1 |
Operative | 346/7,296 (4.74) | 1.84 (1.62 to 2.1) |
Antepartum without indications |
28/1,735(1.61)
| 5.93 (3.88 to 9.05) |
Intrapartum without indications |
86/950(9.05)
| 14.29 (10.91 to 18.72) |
Antepartum with indications |
2,452/27011(9.08)
| 13.28 (12.3 to 14.34) |
Intrapartum with indications |
4,523/44,022(10.27)
| 12.05 (11.33 to 12.82) |
Severe Maternal Outcomes | No (%) | Adjusted OR [95%CI] |
---|---|---|
Africa †
| ||
Spontaneous (reference) | 1011/69,364 (1.46) | 1 to |
Operative | 151/2,298 (6.57) | 2.58 (2.12-3.15) |
Antepartum without indications |
14/63(22.22)
| 71.29 (32.06 to 158.55) |
Intrapartum without indications |
36/202(17.82)
| 40.67 (24.56-67.33) |
Antepartum with indications |
960/2,399(40.02)
| 88.61 (74.88 to 104.86) |
Intrapartum with indications |
1,942/7,396(26.26)
| 54.26 (47.81 to 61.59) |
Americas
††
| ||
Spontaneous (reference) | 946/61130 (1.55) | 1 |
Operative | 50/1533 (3.26) | 2.2 (1.62 to 2.99) |
Antepartum without indications |
6/157(3.82)
| 1.94 (0.77 to 4.9) |
Intrapartum without indications |
10/194(5.15)
| 4 (2.05 to 7.82) |
Antepartum with indications |
803/13759(5.84)
| 3.04 (2.71 to 3.41) |
Intrapartum with indications |
640/20120(3.18)
| 1.91 (1.71 to 2.13) |
Asia
†††
| ||
Spontaneous (reference) | 1190/75057 (1.59) | 1 |
Operative | 145/3465 (4.18) | 1.91 (1.56 to 2.35) |
Antepartum without indications |
8/1515(0.53)
| 2.14 (1.04 to 4.43) |
Intrapartum without indications |
40/554(7.22)
| 12.86 (8.83 to 18.73) |
Antepartum with indications |
689/10853(6.35)
| 8.09 (7.12 to 9.18) |
Intrapartum with indications |
1941/16506(11.76)
| 11.61 (10.56 to 12.76) |
Perinatal outcomes | n/N (%) | Adjusted OR [95%CI] |
---|---|---|
Perinatal mortality†
| ||
Spontaneous (reference) |
3218/205551(1.57)
|
1
|
Operative |
415/7296(5.69)
|
3.16 (2.76 to 3.61)
|
Antepartum without indications |
6/1735(0.35)
|
0.72 (0.26 to 1.97)
|
Intrapartum without indications |
16/950(1.68)
|
2.41 (1.39 to 4.2)
|
Antepartum with indications |
534/27011(1.98)
|
1.3 (1.15 to 1.47)
|
Intrapartum with indications |
1081/44022(2.46)
|
2.01 (1.84 to 2.19)
|
Fetal death
††
| ||
Spontaneous (reference) |
1981/205551 (0.96)
|
1
|
Operative |
291/7296 (3.99)
|
3.25 (2.79 to 3.79)
|
Antepartum without indications |
3/1735(0.17)
|
0.48 (0.12 to 1.98)
|
Intrapartum without indications |
11/950(1.16)
|
2.3 (1.2 to 4.4)
|
Antepartum with indications |
248/27011 (0.92)
|
0.92 (0.78 to 1.09)
|
Intrapartum with indications |
577/44022 (1.31)
|
1.6 (1.43 to 1.79)
|
Early neonatal deaths up to hospital discharge
‡
| ||
Spontaneous (reference) |
1237/203570 (0.61)
|
1
|
Operative |
124/7005 (1.82)
|
2.76 (2.19 to 3.47)
|
Antepartum without indications |
3/1732(0.17)
|
0.88 (0.21 to 3.62)
|
Intrapartum without indications |
5/939(0.53)
|
2.01 (0.8 to 5.06)
|
Antepartum with indications |
286/26477(1.08)
|
1.68 (1.42 to 1.98)
|
Intrapartum with indications |
504/43445(1.16)
|
2.2 (1.94 to 2.5)
|
Stay for ≥7 days in neonatal intensive care unit‡‡
| ||
Spontaneous (reference) |
2704/205551(1.32)
|
1
|
Operative |
203/7296(2.78)
|
1.57 (1.31 to 1.88)
|
Antepartum without indications |
17/1735(0.98)
|
1.18 (0.7 to 1.99)
|
Intrapartum without indications |
16/950(1.68)
|
2.09 (1.21 to 3.6)
|
Antepartum with indications |
1466/27011(5.43)
|
2.63 (2.4 to 2.89)
|
Intrapartum with indications |
1625/44022(3.69)
|
2.77 (2.55 to 3)
|
Severe perinatal outcome‡‡‡
| ||
Spontaneous (reference) |
5820/205551 (2.83)
|
1
|
Operative |
613/7296 (8.4)
|
2.33 (2.07 to 2.62)
|
Antepartum without indications |
22/1735(1.27)
|
1 (0.61 to 1.62)
|
Intrapartum without indications |
32/950(3.37)
|
2.48 (1.66 to 3.69)
|
Antepartum with indications |
1968/27011(7.29)
|
2.05 (1.9 to 2.22)
|
Intrapartum with indications |
2656/44022(6.03)
|
2.42 (2.27 to 2.58)
|