Caesarean section in four South East Asian countries: reasons for, rates, associated care practices and health outcomes

Data on caesarean rates, care practices and health outcomes were collected from the medical records of the 9550 women and their 9665 infants admitted to the nine participating hospitals across South East Asia between January and December 2005.Overall 27% of women had a caesarean section, with rates varying from 19% to 35% between countries and 12% to 39% between hospitals within countries. The most common indications for caesarean were previous caesarean (7.0%), cephalopelvic disproportion (6.3%), malpresentation (4.7%) and fetal distress (3.3%). Neonatal resuscitation rates ranged from 7% to 60% between countries. Prophylactic antibiotics were almost universally given but variations in timing occurred between countries and between hospitals within countries.Rates and reasons for caesarean section and associated clinical care practices and health outcomes varied widely between the four South East Asian countries.Caesarean section is a commonly performed operation on women that is globally increasing in prevalence each year [1-5]. There is a large variation in the rates of caesarean, both in high and low income countries, as well as between different institutions within these countries [3,4].In the past, recommended caesarean rates have been calculated using various methods and concepts, the most common of which is based on the number of births in a hospital. The most widely recommended upper limit rate of caesarean section was 15 percent as advocated by the World Health Organization (WHO) [6]. This was based on caesarean rates of countries with the lowest maternal and neonatal mortality rate at the time of the recommendation, and took into account both developed and developing countries [4,6]. Since then the World Health Organization has published a revision in 1994, stating that acceptable caesarean section rates should range between 5 and 15 percent [7].Caesarean section in developing countries is associated with significant increases in maternal morbidity [4,8] p