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Cited by 262Maternal and Perinatal Health InterventionsMaternal and fetal healthcareReproductive Health and Contraception

Maternal complications and cesarean section without indication: systematic review and meta-analysis

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Mascarello, Keila Cristina, Horta, Bernardo Lessa, Silveira, Mariângela Freitas·2017·Revista de Saúde Pública
DOI 10.11606/s1518-8787.2017051000389PMC PMC5697917
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Abstract

OBJECTIVE: The objective of this study was to determine the risks of severe acute maternal complications associated with cesarean section without medical indication. METHODS: A systematic review was carried out with meta-analysis. The literature search was performed systematically, in multiple stages, in the PubMed, Lilacs, and Web of Science databases using the following descriptors: (postpartum period) and (cesarean section or natural childbirth) and ((morbidity or mortality) or (postpartum hemorrhage) or (puerperal infection) or (surgical infection) or (puerperal disorders)). The protocol of the study was registered at PROSPERO as CRD42016032933. A total of 1,328 articles were found; after selection, eight publications that met the study objective and inclusion criteria were selected, with information on 1,051,543 individuals. RESULTS: The results obtained in the meta-analyses indicate that women with cesarean section have a higher chance of maternal death (OR = 3.10, 95%CI 1.92–5.00) and postpartum infection (OR = 2.83, 95%CI, 1.585.06), but they have a lower chance of hemorrhage (OR = 0.52, 95%CI 0.48–0.57). For the blood transfusion outcome, the group effect was not associated with the type of delivery (95%CI 0.88–2.81). CONCLUSIONS: The quality of evidence was considered low for hemorrhage and blood transfusion and moderate for postpartum infection and maternal death. Thus, cesarean sections should be performed with caution and safety, especially when its benefits outweigh the risks of a surgical procedure.

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  • FOC is correlated with women's positive attitudes towards obstetric interventions, as pain relief and caesarean sections on maternal request have increased globally.

    “FOC has also been shown to be correlated with women’s positive attitudes towards obstetric interventions, as pain relief and caesarean sections on maternal request have increased globally (Mascarello et al., Citation2017).”

    From The feasibility and acceptability of a single-session Acceptance and Commitment Therapy (ACT) intervention to support women self-reporting fear of childbirth in a first pregnancy. (2023) · cites this paper as Mascarello et al., 2017

    The Introduction (page unavailable) reports that cesarean-section rates have risen worldwide. The Discussion (page unavailable) says some women view cesarean delivery positively and that traumatic birth experiences may influence requests for it. Neither passage establishes a correlation with fear of childbirth (FOC), nor does the paper report a global increase in pain relief or cesarean sections on maternal request. (LLM, conf=0.84)

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Research works printed but not linked: 26

  1. [1]Allen VM O’Connell CM Baskett TF Maternal morbidity associated with cesarean section without labor compared with induction of labor at term Obstet Gynecol 2006 108 2 286 294 https://doi.org/10.1097/01.AOG.0000215988.23224.e4 16880297 · DOI
  2. [2]Allen VM O’Connell CM Liston RM Baskett TF Maternal morbidity associated with cesarean section without labor compared with spontaneous onset of labor at term Obstet Gynecol 2003 102 3 477 482 https://doi.org/10.1016/S0029-7844(03)00570-2 12962927 · DOI
  3. [3]Althabe F Belizan JM Villar J Alexander S Bergel E Ramos S et al Mandatory second opinion to reduce rates of unnecessary caesarean sections in Latin America: a cluster randomised controlled trial Lancet 2004 363 9425 1934 1940 https://doi.org/10.1016/S0140-6736(04)16406-4 15194252 · DOI
  4. [4]Azam S Khanam A Tirlapur S Khan K Planned caesarean section or trial of vaginal delivery? A meta-analysis Curr Opin Obstet Gynecol 2014 26 6 461 468 https://doi.org/10.1097/GCO.0000000000000114 25304604 · DOI
  5. [5]Béhague DP Victora CG Barros FC Consumer demand for caesarean sections in Brazil: informed decision making, patient choice, or social inequality? A population based birth cohort study linking ethnographic and epidemiological methods BMJ 2002 324 7343 942 945 https://doi.org/10.1136/bmj.324.7343.942 11964338 PMC102326 · DOI
  6. [6]Belizán JM Cafferata ML Althabe F Buekens P Risk of patient choice cesarean Birth 2006 33 2 167 169 https://doi.org/10.1111/j.0730-7659.2006.0098b.x 16732786 · DOI
  7. [7]Bernardo LS Simões R Bernardo WM Toledo SF Hazzan MA Chan HF et al Mother-requested cesarean section compared to vaginal delivery: a systematic review Rev Assoc Med Bras 2014 60 4 302 304 https://doi.org/10.1590/1806-9282.60.04.006 25211411 · DOI
  8. [8]Betrán AP Merialdi M Lauer JA Bing-Shun W Thomas J Van Look P et al Rates of caesarean section: analysis of global, regional and national estimates Paediatr Perinat Epidemiol 2007 21 2 98 113 https://doi.org/10.1111/j.1365-3016.2007.00786.x 17302638 · DOI
  9. [9]Boyles SH Li H Mori T Osterweil P Guise JM Effect of mode of delivery on the incidence of urinary incontinence in primiparous women Obstet Gynecol 2009 113 1 134 141 https://doi.org/10.1097/AOG.0b013e318191bb37 19104369 · DOI
  10. [10]Cruz CZ Thompson EL O’Rourke K Nembhard WN Cesarean section and the risk of emergency peripartum hysterectomy in high-income countries: a systematic review Arch Gynecol Obstet 2015 292 6 1201 1215 https://doi.org/10.1007/s00404-015-3790-2 26104125 · DOI
  11. [11]Declercq E Barger M Cabral HJ Evans SR Kotelchuck M Simon C et al Maternal outcomes associated with planned primary cesarean birth compared with planned vaginal birth Obstet Gynecol 2007 109 3 669 677 https://doi.org/10.1097/01.AOG.0000255668.20639.40 17329519 · DOI
  12. [12]Deneux-Tharaux C Carmona E Bouvier-Colle MH Bréart G Postpartum maternal mortality and cesarean section Obstet Gynecol 2006 108 3 Pt 1 541 548 https://doi.org/10.1097/01.AOG.0000233154.62729.24 16946213 · DOI
  13. [14]Farchi S Polo A Franco F Di Lallo D Guasticchi G Severe postpartum morbidity and mode of delivery: a retrospective cohort study Acta Obstet Gynecol Scand 2010 89 12 1600 1603 https://doi.org/10.3109/00016349.2010.515298 21050153 · DOI
  14. [17]Hall MH Bewley S Maternal mortality and mode of delivery Lancet 1999 354 9180 776 https://doi.org/10.1016/S0140-6736(05)76016-5 10475219 · DOI
  15. [18]Kamilya G Seal SL Mukherji J Bhattacharyya SK Hazra A Maternal mortality and cesarean section: an analytical observational study J Obstet Gynaecol Res 2010 36 2 248 253 https://doi.org/10.1111/j.1447-0756.2009.01125.x 20492373 · DOI
  16. [19]Koroukian SM Relative risk of postpartum complications in the Ohio Medicaid population: vaginal versus cesarean section Med Care Res Rev 2004 61 2 203 224 https://doi.org/10.1177/1077558703260123 15155052 · DOI
  17. [20]Latham SR Norwitz ER Ethics and “cesarean section on maternal demand” Semin Perinatol 2009 33 6 405 409 https://doi.org/10.1053/j.semperi.2009.07.009 19914526 · DOI
  18. [23]Molina G Weiser TG Lipsitz SR Esquivel MM Uribe-Leitz T Azad T et al Relationship between cesarean section rate and maternal and neonatal mortality JAMA 2015 314 21 2263 2270 https://doi.org/10.1001/jama.2015.15553 26624825 · DOI
  19. [24]Pereira MG Galvão TF Heterogeneidade e viés de publicação em revisões sistemáticas Epidemiol Serv Saude 2014 23 4 775 778 https://doi.org/10.5123/S1679-49742014000400021 · DOI
  20. [25]Ronsmans C Holtz S Stanton C Socioeconomic differentials in caesarean rates in developing countries: a retrospective analysis Lancet 2006 368 9546 1516 1523 https://doi.org/10.1016/S0140-6736(06)69639-6 17071285 · DOI
  21. [26]Rortveit G Hannestad YS Association between mode of delivery and pelvic floor dysfunction Tidsskr Nor Laegeforen 2014 34 19 1848 1852 https://doi.org/10.4045/tidsskr.13.0860 25314985 · DOI
  22. [27]Souza JP Gulmezoglu A Lumbiganon P Laopaiboon M Carroli G Fawole B et al Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health BMC Med 2010 8 71 https://doi.org/10.1186/1741-7015-8-71 PMC2993644 21067593 · DOI
  23. [28]Victora CG Aquino EM Leal MC Monteiro CA Barros FC Szwarcwald CL Maternal and child health in Brazil: progress and challenges Lancet 2011 377 9780 1863 1876 https://doi.org/10.1016/S0140-6736(11)60138-4 21561656 · DOI
  24. [29]Villar J Valladares E Wojdyla D Zavaleta N Carroli G Velazco A et al Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America Lancet 2006 367 9525 1819 1829 https://doi.org/10.1016/S0140-6736(06)68704-7 16753484 · DOI
  25. [31]World Health Organization Appropriate technology for birth Lancet 1985 24 2 8452 436 437 https://doi.org/10.1016/S0140-6736(85)92750-3 2863457 · DOI · Paper page
  26. [33]Ye J Betrán AP Guerrero Vela M Souza JP Zhang J Searching for the optimal rate of medically necessary cesarean section Birth 2014 41 3 237 244 https://doi.org/10.1111/birt.12104 24720614 · DOI

Cited by

Sorted by citations

Authors
Mascarello, K. C., Horta, B. L., & Silveira, M. F.
Affiliations
Universidade Federal de Pelotas (BR)
ORCID
Venue
Revista de Saúde Pública
Publisher
Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
Published
2017-11-27
Volume
51
Pages
105
ISSN
  • 0034-8910 (ISSN-L)
  • 1518-8787
DOI
10.11606/s1518-8787.2017051000389
PMC
PMC5697917
OpenAlex
W2769696181
Cited by
262
References
3
Citations by year
2026: 15 · 2025: 19 · 2024: 42 · 2023: 42 · 2022: 41 · 2021: 49 · 2020: 31 · 2019: 16 · 2018: 6 · 2017: 1
FWCI
2.53
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Revista de Saúde Pública (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, other-oa)
  • Americanae (AECID Library) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
Keywords
maternal complications, maternal mortality, postpartum hemorrhage, postpartum infection, surgical site infection, blood transfusion, postpartum period, natural childbirth
MeSH terms
Blood Transfusion, Cesarean Section, Female, Postpartum Hemorrhage, Humans, Maternal Mortality, Natural Childbirth, Pregnancy, Pregnancy Outcome, Puerperal Disorders, Risk Factors, Postpartum Period

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