↓ Skip to main content

What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies

Overview of attention for article published in Reproductive Health, June 2015
Altmetric Badge

About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • Among the highest-scoring outputs from this source (#17 of 1,222)
  • High Attention Score compared to outputs of the same age (98th percentile)

Mentioned by

news
9 news outlets
policy
1 policy source
twitter
10 tweeters
facebook
6 Facebook pages
video
1 video uploader

Citations

dimensions_citation
231 Dimensions

Readers on

mendeley
448 Mendeley
You are seeing a free-to-access but limited selection of the activity Altmetric has collected about this research output. Click here to find out more.
Title
What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies
Published in
Reproductive Health, June 2015
DOI 10.1186/s12978-015-0043-6
Pubmed ID
Authors

Ana Pilar Betran, Maria Regina Torloni, Jun Zhang, Jiangfeng Ye, Rafael Mikolajczyk, Catherine Deneux-Tharaux, Olufemi Taiwo Oladapo, João Paulo Souza, Özge Tunçalp, Joshua Peter Vogel, Ahmet Metin Gülmezoglu

Abstract

In 1985, WHO stated that there was no justification for caesarean section (CS) rates higher than 10-15 % at population-level. While the CS rates worldwide have continued to increase in an unprecedented manner over the subsequent three decades, concern has been raised about the validity of the 1985 landmark statement. We conducted a systematic review to identify, critically appraise and synthesize the analyses of the ecologic association between CS rates and maternal, neonatal and infant outcomes. Four electronic databases were searched for ecologic studies published between 2000 and 2014 that analysed the possible association between CS rates and maternal, neonatal or infant mortality or morbidity. Two reviewers performed study selection, data extraction and quality assessment independently. We identified 11,832 unique citations and eight studies were included in the review. Seven studies correlated CS rates with maternal mortality, five with neonatal mortality, four with infant mortality, two with LBW and one with stillbirths. Except for one, all studies were cross-sectional in design and five were global analyses of national-level CS rates versus mortality outcomes. Although the overall quality of the studies was acceptable; only two studies controlled for socio-economic factors and none controlled for clinical or demographic characteristics of the population. In unadjusted analyses, authors found a strong inverse relationship between CS rates and the mortality outcomes so that maternal, neonatal and infant mortality decrease as CS rates increase up to a certain threshold. In the eight studies included in this review, this threshold was at CS rates between 9 and 16 %. However, in the two studies that adjusted for socio-economic factors, this relationship was either weakened or disappeared after controlling for these confounders. CS rates above the threshold of 9-16 % were not associated with decreases in mortality outcomes regardless of adjustments. Our findings could be interpreted to mean that at CS rates below this threshold, socio-economic development may be driving the ecologic association between CS rates and mortality. On the other hand, at rates higher than this threshold, there is no association between CS and mortality outcomes regardless of adjustment. The ecological association between CS rates and relevant morbidity outcomes needs to be evaluated before drawing more definite conclusions at population level.

Twitter Demographics

The data shown below were collected from the profiles of 10 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 448 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Netherlands 1 <1%
Norway 1 <1%
Kenya 1 <1%
Brazil 1 <1%
Mexico 1 <1%
Congo, The Democratic Republic of the 1 <1%
Unknown 442 99%

Demographic breakdown

Readers by professional status Count As %
Student > Master 85 19%
Researcher 60 13%
Student > Bachelor 53 12%
Student > Doctoral Student 37 8%
Student > Ph. D. Student 36 8%
Other 106 24%
Unknown 71 16%
Readers by discipline Count As %
Medicine and Dentistry 198 44%
Nursing and Health Professions 65 15%
Social Sciences 26 6%
Psychology 10 2%
Economics, Econometrics and Finance 9 2%
Other 45 10%
Unknown 95 21%

Attention Score in Context

This research output has an Altmetric Attention Score of 87. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 01 May 2021.
All research outputs
#325,454
of 19,225,771 outputs
Outputs from Reproductive Health
#17
of 1,222 outputs
Outputs of similar age
#4,418
of 241,119 outputs
Outputs of similar age from Reproductive Health
#1
of 1 outputs
Altmetric has tracked 19,225,771 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 98th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 1,222 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 10.9. This one has done particularly well, scoring higher than 98% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 241,119 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 98% of its contemporaries.
We're also able to compare this research output to 1 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them