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The study objective was to quantify maternal and perinatal morbidity and mortality associated with <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> compared with vaginal delivery (<jats:styled-content style=\"fixed-case\">VD<\/jats:styled-content>) both within and across sites in low\u2010 and middle\u2010income countries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>A prospective population\u2010based study including home and facility births in 337\u00a0153 women with a <jats:styled-content style=\"fixed-case\">VD<\/jats:styled-content> and 47\u00a0308 women with a <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> from 2010 to 2015 was performed in Guatemala, India, Kenya, Pakistan, Zambia and Democratic Republic of Congo. Women were enrolled during pregnancy; delivery and 6\u2010week follow\u2010up data were collected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Across all sites, <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> rates increased from 8.6% to 15.2%, but remained low in African sites. Younger, nulliparous women were more likely to have a <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>, as were women with higher education and those delivering an infant weighing 1500\u20132499\u00a0g. Across all sites, maternal and neonatal mortality was higher, and stillbirths were lower, in pregnancies delivered by <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>. Antepartum and postpartum complications as well as obstetric interventions and treatments were more common among women who underwent <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>. In stratified analyses, all outcomes were worse in women with a <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> compared with <jats:styled-content style=\"fixed-case\">VD<\/jats:styled-content> in African compared to non\u2010African sites.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> rates increased across all sites during the study period, but at more pronounced rates in the non\u2010African sites. <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> was associated with reduced postpartum hemorrhage and lower rates of stillbirths in the non\u2010African sites. In the African sites, <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> was associated with an increase in all adverse outcomes. Further studies are necessary to better understand the increase in adverse outcomes with <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> in the African sites.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13098","type":"journal-article","created":{"date-parts":[[2017,1,20]],"date-time":"2017-01-20T23:03:32Z","timestamp":1484953412000},"page":"410-420","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":67,"title":["A prospective study of maternal, fetal and neonatal outcomes in the setting of cesarean section in low\u2010 and middle\u2010income countries"],"prefix":"10.1111","volume":"96","author":[{"given":"Margo S.","family":"Harrison","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Columbia University New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2000-4001","authenticated-orcid":false,"given":"Omrana","family":"Pasha","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences Aga Khan University Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6797-8631","authenticated-orcid":false,"given":"Sarah","family":"Saleem","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences Aga Khan University Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumera","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences Aga Khan University Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elwyn","family":"Chomba","sequence":"additional","affiliation":[{"name":"University Teaching Hospital University of Zambia Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waldemar A.","family":"Carlo","sequence":"additional","affiliation":[{"name":"Division of Neonatology University of Alabama Birmingham AL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana L.","family":"Garces","sequence":"additional","affiliation":[{"name":"Planning Unit Institute of Nutrition of Central America and Panama (INCAP) Guatemala City Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy F.","family":"Krebs","sequence":"additional","affiliation":[{"name":"School of Medicine University of Colorado Denver CO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. 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