{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:42:32Z","timestamp":1791909752918,"version":"4.3.4"},"reference-count":40,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2022,1,15]],"date-time":"2022-01-15T00:00:00Z","timestamp":1642204800000},"content-version":"unspecified","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland."}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,12,30]]},"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Caesarean section (CS) conducted before labour (prelabour CS (PLCS)), compared with vaginal birth, may pose additional maternal and perinatal risks. No multicountry analysis has examined PLCS in low-income and middle-income countries (LMICs). This study assessed rates, risk factors and associations of PLCS with perinatal outcomes in LMICs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Population-based cross-sectional surveys.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Demographic and Health Surveys conducted between 2015 and 2018 in 26 LMICs (13 countries in Africa, 11 in Asia and 2 in the Americas).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Women aged 15\u201349 years with singleton term births.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Main outcomes were early neonatal mortality, neonatal mortality, early breastfeeding (within 1\u2009hour of birth), skin-to-skin contact and duration of hospital stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>255\u2009227\u2009women were included in the main analysis. Average rates of primary PLCS ranged from 1.3% in Zambia to 19.5% in Maldives. Median PLCS rate was 1.8% in the poorest versus 5.8% in the richest subgroups.<\/jats:p>\n                    <jats:p>Higher maternal age, education, economic status and BMI, lower parity, urban residence, delivery in private hospitals, larger baby size, having health insurance, more antenatal care (ANC) visits, ANC by a doctor and ANC in private hospitals were associated with increased primary PLCS.<\/jats:p>\n                    <jats:p>Across the 26 countries, primary PLCS, compared with vaginal delivery, was associated with increased neonatal mortality (adjusted odds ratio, aOR 1.2, 95%\u2009CI 1.0 to 1.5), decreased early breastfeeding (aOR 0.4, 95%\u2009CI 0.3 to 0.5) and skin-to-skin contact (aOR 0.4, 95%\u2009CI 0.3 to 0.5) and longer hospital stay (aOR 6.6, 95%\u2009CI 5.9 to 7.4). No significant association was found for early neonatal mortality (aOR 1.2, 95%\u2009CI 0.9 to 1.5).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Primary PLCS, compared with vaginal birth, is associated with adverse perinatal outcomes in singleton term pregnancies in LMICs. Caesarean births should be audited regularly to monitor trends, appropriateness and context-specific drivers of CS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-053049","type":"journal-article","created":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T11:06:25Z","timestamp":1642417585000},"page":"e053049","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Association between prelabour caesarean section and perinatal outcomes: analysis of demographic and health surveys from 26 low-income and middle-income countries"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2709-3609","authenticated-orcid":false,"given":"Newton","family":"Opiyo","sequence":"first","affiliation":[{"name":"UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saverio","family":"Bellizzi","sequence":"additional","affiliation":[{"name":"Country Office, World Health Organization, Amman, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4944-0720","authenticated-orcid":false,"given":"Maria Regina","family":"Torloni","sequence":"additional","affiliation":[{"name":"Evidence-Based Healthcare Post-Graduate Program, Department of Medicine, S\u00e3o Paulo Federal University, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joao Paulo","family":"Souza","sequence":"additional","affiliation":[{"name":"Department of Social Medicine, Ribeir\u00e3o Preto Medical School, University of S\u00e3o Paulo, Ribeirao Preto, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Pilar","family":"Betran","sequence":"additional","affiliation":[{"name":"UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,1,17]]},"reference":[{"key":"2025121601165979000_12.1.e053049.1","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-016-0857-4","article-title":"Diagnosing onset of labor: a systematic review of definitions in the research literature","volume":"16","author":"Hanley","year":"2016","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025121601165979000_12.1.e053049.2","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.bpobgyn.2020.02.006","article-title":"The initiation of labour at term gestation: physiology and practice implications","volume":"67","author":"Hundley","year":"2020","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"2025121601165979000_12.1.e053049.3","doi-asserted-by":"crossref","DOI":"10.1111\/jne.12912","article-title":"Birth signalling hormones and the developmental consequences of caesarean delivery","volume":"33","author":"Kenkel","year":"2021","journal-title":"J Neuroendocrinol"},{"key":"2025121601165979000_12.1.e053049.4","doi-asserted-by":"publisher","DOI":"10.1891\/1058-1243.24.3.145"},{"key":"2025121601165979000_12.1.e053049.5","unstructured":"Who recommendations: intrapartum care for a positive childbirth experience. 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