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Table 3 The relationship between mode of delivery and severe maternal outcomes (that is, death, admission to ICU, blood transfusion, hysterectomy)

From: 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

Maternal outcomes n/N (%) Adjusted OR [95%CI]
Death*   
   Spontaneous (reference) 196/205,551 (0.10) 1
   Operative 34/7,296 (0.47) 2.9 (1.84 to 4.56)
   Antepartum without indications 0/1,735(0) Not estimated
   Intrapartum without indications 2/950(0.21) 3.21 (0.78 to 13.2)
   Antepartum with indications 36/27,011(0.13) 1.51 (0.97 to 2.33)
   Intrapartum with indications 74/44,022(0.17) 1.7 (1.24 to 2.33)
Admission to ICU**   
   Spontaneous (reference) 1,189/205,551 (0.58) 1
   Operative 172/7,296 (2.36) 2.27 (1.89 to 2.73)
   Antepartum without indications 22/1,735(1.27) 30.75 (18.12 to 52.17)
   Intrapartum without indications 67/950(7.05) 58.85 (41.46 to 83.52)
   Antepartum with indications 1,741/27,011(6.45) 63.4 (56.32 to 71.36)
   Intrapartum with indications 3,457/44,022(7.85) 51.3 (46.56 to 56.59)
Blood transfusion †   
   Spontaneous (reference) 1,940/205,303 (0.94) 1
   Operative 198/7,287 (2.72) 2.11 (1.79 to 2.48)
   Antepartum without indications 9/1,735(0.52) 1.79 (0.91 to 3.52)
   Intrapartum without indications 18/950(1.89) 3.7 (2.24 to 6.1)
   Antepartum with indications 892/26,967(3.31) 3.75 (3.39 to 4.14)
   Intrapartum with indications 1,475/43,928(3.36) 3.85 (3.55 to 4.16)
Hysterectomy ††   
   Spontaneous (reference) 82/205,299 (0.04) 1
   Operative 11/7,278 (0.15) 3.38 (1.73 to 6.59)
   Antepartum without indications 0/1,733(0) Not estimated
   Intrapartum without indications 4/949(0.42) 13.53 (4.79 to 38.2)
   Antepartum with indications 100/26,916(0.37) 6.11 (4.38 to 8.52)
   Intrapartum with indications 118/43,889(0.27) 6.68 (4.91 to -9.09)
Severe Maternal Outcomes †††   
   Spontaneous (reference) 3,147/205,551 (1.53) 1
   Operative 346/7,296 (4.74) 1.84 (1.62 to 2.1)
   Antepartum without indications 28/1,735(1.61) 5.93 (3.88 to 9.05)
   Intrapartum without indications 86/950(9.05) 14.29 (10.91 to 18.72)
   Antepartum with indications 2,452/27011(9.08) 13.28 (12.3 to 14.34)
   Intrapartum with indications 4,523/44,022(10.27) 12.05 (11.33 to 12.82)
  1. *Total number of years attended school, birth weight, Pregnancy induced hypertension or preeclampsia or eclampsia or chronic hypertension, suspected fetal growth impairment, vaginal bleeding in second half of pregnancy, Breech or other non-cephalic presentation, referred for complication related to pregnancy or delivery, induced labour, HIV positive, Any other medical complication during pregnancy (excluding chronic hypertension) and incentive for caesarean section (no missing data for this outcome)
  2. **Maternal age, total number of years attended school, birth weight, prelabour rupture of membranes, pregnancy induced hypertension or preeclampsia or eclampsia or chronic hypertension, vaginal bleeding in second half of pregnancy, Referred for complication related to pregnancy or delivery, induced labour, HIV positive, any other medical complication during pregnancy (excluding chronic hypertension), incentive for caesarean section and country (no missing data for this outcome)
  3. †Maternal age, total number of years attended school, primiparaous, birth weight, neonatal death or stillbirth, pregnancy induced hypertension or preeclampsia or eclampsia or chronic hypertension, vaginal bleeding in second half of pregnancy, any antenatal antibiotic treatment, referred for complication related to pregnancy or delivery, induced labour, hiv positive, any other medical complication during pregnancy (excluding chronic hypertension), incentive for caesarean section and country (395 participants with missing data for this outcome)
  4. †† Maternal age, Primiparaous, birth weight, vaginal bleeding in second half of pregnancy, referred for complication related to pregnancy or delivery, any other medical complication during pregnancy (excluding chronic hypertension), country and incentive for caesarean section (501 participants with missing data for this outcome)
  5. †††Maternal age, total number of years attended school, birth weight, neonatal death or stillbirth, prelabour rupture of membranes, pregnancy induced hypertension or preeclampsia or eclampsia or chronic hypertension, vaginal bleeding in the second half of pregnancy, any antenatal antibiotic treatment, breech or other non-cephalic presentation, referred for complication related to pregnancy or delivery, induced labour, hiv positive, any other medical complication during pregnancy (excluding chronic hypertension), country and incentive for caesarean section (data available for at least one of the included outcomes for all participants)
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BMC Medicine

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