Rates and Implications of Caesarean Sections in Latin America: Ecological Study

Belizán, José M.; Althabe, Fernando; Barros, Fernando C.; Alexander, Sophie

doi:10.1097/00006254-200005000-00007

Cited by 162 publications

(220 citation statements)

References 7 publications

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“…The fi ve intervention pairs were as follows: (1) blunt versus sharp abdominal entry; (2) exteriorisation of the uterus for repair versus intraabdominal repair; (3) single-layer versus double-layer closure of the uterus; (4) closure versus non-closure of the peritoneum (pelvic and parietal); and (5) chromic catgut versus polyglactin-910 for uterine repair. The methods have been summarised previously.…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…[1][2][3] Caesarean section carries a risk of short-term postoperative morbidity, for example, fever, pain, post-partum haemorrhage, damage to the bladder or ureters, and thromboembolic disease. Long-term clinical and obstetric problems include chronic pain, infertility, bowel obstruction, abnormal placen tation and its consequences, and uterine rupture.…”

Section: Introductionmentioning

confidence: 99%

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Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial

Ábalos¹,

et al. 2013

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SummaryBackground Variations exist in the surgical techniques used for caesarean section and many have not been rigorously assessed in randomised controlled trials. We aimed to assess whether any surgical techniques were associated with improved outcomes for women and babies.Methods CORONIS was a pragmatic international 2×2×2×2×2 non-regular fractional, factorial, unmasked, randomised controlled trial that examined fi ve elements of the caesarean section technique in intervention pairs. CORONIS was undertaken at 19 sites in Argentina, Chile, Ghana, India, Kenya, Pakistan, and Sudan. Each site was assigned to three of the fi ve intervention pairs: blunt versus sharp abdominal entry; exteriorisation of the uterus for repair versus intraabdominal repair; single-layer versus double-layer closure of the uterus; closure versus non-closure of the peritoneum (pelvic and parietal); and chromic catgut versus polyglactin-910 for uterine repair. Pregnant women were eligible if they were to undergo their fi rst or second caesarean section through a planned transverse abdominal incision. Women were randomly assigned by a secure web-based number allocation system to one intervention from each of the three assigned pairs. All investigators, surgeons, and participants were unmasked to treatment allocation. The primary outcome was the composite of death, maternal infectious morbidity, further operative procedures, or blood transfusion (>1 unit) up to the 6-week follow-up visit. Women were analysed in the groups into which they were allocated. The CORONIS Trial is registered with Current Controlled Trials: ISRCTN31089967. Interpretation These fi ndings suggest that any of these surgical techniques is acceptable. However, longer-term follow-up is needed to assess whether the absence of evidence of short-term eff ects will translate into an absence of long-term eff ects.Funding UK Medical Research Council and WHO.

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Section: Study Design and Participantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial

Ábalos¹,

et al. 2013

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“…Obstetricians' fear of negative publicity drives them to practice defensive medicine (Table 1). This has, at least two implications: First, it leads to a too high Caesarean section rate in most countries [40][41][42][43][44][45]. For example, Caesarean sections are now performed in over 22 per cent of all births in Great Britain [43] and in 30 per cent of all births in the USA [42].…”

Section: Discussionmentioning

confidence: 99%

The impact of the mass media on obstetricians’ behavior in Norway

2017

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Little is known about how physicians and hospitals respond to the risk of being negatively exposed in the mass media. We assume that newspapers will cover events more closely in the areas where they have most of their circulation. Within such areas the likelihood of negative publicity increases. The research question is whether obstetricians respond to negative newspaper coverage by choosing the least risky method of delivery, i.e. Caesarean section. This was tested on a large set of data from the Medical Birth Registry of Norway for the period 2000-2011. The Registry contains detailed medical information about all deliveries, for both the mother and the infant. This set of data was merged with a set of data that contained information about newspaper coverage for the municipalities in which all hospitals were located. Altogether, more than 620 000 deliveries in 46 municipalities were included in the study. The data were analyzed using a hospital 3 fixed effects regression. The main result was that newspaper coverage had a significant positive effect on the probability of having a Caesarean section. Several supplementary analyses supported the main finding. Altogether, our results indicate that obstetricians are sensitive to the risk of being exposed in the mass media. This is likely to be because obstetricians care about their reputation.

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“…For example, Demographic and Health Survey data show that private hospitals in Brazil (36% to 72%), 91 México (52%) and Colombia (59%) have the highest caesarean section rates in the world. 92 • Conversely, when a system of giving a lumpsum payment for 100 deliveries was instituted in a scheme in Gujarat, India, the caesarean section rate dropped disproportionately among some segments of the population, mainly due to private physicians refusing to perform them at the given rate and referring patients to the public health service (Werner Soors, personal communication).…”

Section: Here Are Two Examples Of What Has Happenedmentioning

confidence: 99%

International health policy and stagnating maternal mortality: is there a causal link?

Unger

Dessel

Sen

et al. 2009

Reproductive Health Matters

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Rates and Implications of Caesarean Sections in Latin America: Ecological Study

Abstract: 12 Blass EM, Smith BA. Differential effects of sucrose, fructose, glucose, and lactose on crying in 1-to 3-day-old human infants: qualitative and quantitative considerations.

Cited by 162 publications

References 7 publications

Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial

Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial

The impact of the mass media on obstetricians’ behavior in Norway

International health policy and stagnating maternal mortality: is there a causal link?

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