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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
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • Among the highest-scoring outputs from this source (#22 of 1,352)
  • High Attention Score compared to outputs of the same age (98th percentile)

Mentioned by

news
9 news outlets
policy
1 policy source
twitter
12 tweeters
facebook
6 Facebook pages

Citations

dimensions_citation
282 Dimensions

Readers on

mendeley
509 Mendeley
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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 12 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 509 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 503 99%

Demographic breakdown

Readers by professional status Count As %
Student > Master 93 18%
Researcher 65 13%
Student > Bachelor 57 11%
Student > Ph. D. Student 39 8%
Student > Doctoral Student 37 7%
Other 118 23%
Unknown 100 20%
Readers by discipline Count As %
Medicine and Dentistry 208 41%
Nursing and Health Professions 71 14%
Social Sciences 28 6%
Psychology 12 2%
Economics, Econometrics and Finance 10 2%
Other 54 11%
Unknown 126 25%

Attention Score in Context

This research output has an Altmetric Attention Score of 88. 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 28 February 2022.
All research outputs
#373,863
of 21,677,744 outputs
Outputs from Reproductive Health
#22
of 1,352 outputs
Outputs of similar age
#4,502
of 246,005 outputs
Outputs of similar age from Reproductive Health
#1
of 1 outputs
Altmetric has tracked 21,677,744 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 1,352 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 11.3. 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 246,005 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