There
has been concern about rising rates of caesarean section worldwide.
This Article reports the third phase of the WHO global survey, which
aimed to estimate the rate of different methods of delivery and to
examine the relation between method of delivery and maternal and
perinatal outcomes in selected facilities in Africa and Latin America
in 2004—05, and in Asia in 2007—08.

Nine
countries participated in the Asia global survey: Cambodia, China,
India, Japan, Nepal, Philippines, Sri Lanka, Thailand, and Vietnam. In
each country, the capital city and two other regions or provinces were
randomly selected. We studied all women admitted for delivery during 3
months in institutions with 6000 or fewer expected deliveries per year
and during 2 months in those with more than 6000 deliveries. We
gathered data for institutions to obtain a detailed description of the
health facility and its resources for obstetric care. We obtained data
from women's medical records to summarise obstetric and perinatal
events.

We
obtained data for 109 101 of 112 152 deliveries reported in 122
recruited facilities (97% coverage), and analysed 107 950 deliveries.
The overall rate of caesarean section was 27·3% (n=29 428) and of
operative vaginal delivery was 3·2% (n=3465). Risk of maternal
mortality and morbidity index (at least one of: maternal mortality,
admission to intensive care unit [ICU], blood transfusion,
hysterectomy, or internal iliac artery ligation) was increased for
operative vaginal delivery (adjusted odds ratio 2·1, 95% CI 1·7—2·6)
and all types of caesarean section (antepartum without indication 2·7,
1·4—5·5; antepartum with indication 10·6, 9·3—12·0; intrapartum without
indication 14·2, 9·8—20·7; intrapartum with indication 14·5,
13·2—16·0). For breech presentation, caesarean section, either
antepartum (0·2, 0·1—0·3) or intrapartum (0·3, 0·2—0·4), was associated
with improved perinatal outcomes, but also with increased risk of stay
in neonatal ICU (2·0, 1·1—3·6; and 2·1, 1·2—3·7, respectively).

To improve maternal and perinatal outcomes, caesarean section should be done only when there is a medical indication.