Article by Jackie Vicksman

In March 2019, the Lancet published a study titled “Maternal and perinatal mortality and complications associated with caesarean section in low-income and middle-income countries: a systematic review and meta-analysis.” In one of the most comprehensive studies to date, a research group from the Queen Mary University of London found that a “disproportionately high” number of women in low-income and middle-income countries (LMICs) are dying due to caesarean sections, especially in Sub-Saharan countries. The mortality rate was 7.6 out of 1000 women who had the procedure and in Sub-Saharan countries the number rose to 10.9/1000. The study used a systematic review of online databases and analyzed information from 196 studies in 67 LMICs. The study found that risks arise when the procedure is not preceded by quality antenatal care, delayed during obstructed labor, or not considered for at-risk women until complications arise. The biggest risk was for women receiving emergency c-sections in the second stage of labor. In addition, the study acknowledged its method limitations: it could not account for “underlying obstetric and socioeconomic factors” which may have led to incorrectly identifying complications as a direct result of the procedure and not an underlying risk factor. Also, they reviewed very few studies from Europe, Central Asia, the Middle East, and North Africa. Ultimately, in order to improve the reported outcomes, the study recommends increasing the number of skilled providers in LMICs, better training for more appropriate decisions surrounding caesarean procedures, and greater access to “safe surgical environments.”

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