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Global incidence of caesarean deliveries on maternal request: a systematic review and meta-regression
T Begum1,2,3, K M Saif-Ur-Rahman3,4, F Yaqoot1,5
1Institute for Social Science Research, The University of Queensland, Indooroopilly, Queensland, Australia.
Background:
Caesarean delivery on maternal request (CDMR) is considered a significant contributor to the unprecedented increase in caesarean deliveries (CDs) for nonclinical reasons. Current literature lacks a reliable assessment of the rate of CDMR, which hinders the planning and delivery of appropriate interventions for reducing CDMR rates.
Objectives:
To conduct a systematic review of the literature and meta-regression to explore the global incidence of CDMR.
Search Strategy:
PubMed, Embase, CINAHL, Medline, Google scholar and grey literature were searched from January 1985 to May 2019.
Selection Criteria:
Observational studies that report CDMR data were included. We excluded non-English articles, case notes, editorial reviews and articles reporting elective CDs from pregnancy risk factors.
Data Collection And Analysis:
Two reviewers independently conducted the screening and quality appraisal using a validated tool. The weighted average of CDMR over total deliveries (absolute proportion) and by total CDs (relative proportion) were generated. Quality-effects meta-regression was used to explain the variability of the CDMR estimates by moderators, including study methodology and demography of study participants.
Main Results:
We identified 31 articles from 14 countries that include 5 million total births. The absolute proportion of CDMR varies between 0.2 and 42.0%, with significant variations across studies and subgroups. The economic status of the country and study year together explained 84% of the absolute and 76% of the relative proportion of CDMR variation.
Conclusions:
An appropriate reporting of CDMR should be a key priority in maternal health policies and practices.
Tweetable Abstract:
Globally, the proportion of maternal requested caesarean delivery has mostly been influenced by the economic status of the country.
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