{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T22:01:26Z","timestamp":1776722486319,"version":"3.51.2"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T00:00:00Z","timestamp":1715212800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Maternal mortality is a critical indicator of healthcare quality, and in Mexico, this has become increasingly concerning due to the stagnation in its decline, alongside a concurrent increase in cesarean section (C-section) rates. This study characterizes maternal deaths in Mexico, focusing on estimating the association between obstetric risk profiles, cause of death, and mode of delivery.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Utilizing a retrospective observational design, 4,561 maternal deaths in Mexico from 2010\u20132014 were analyzed. Data were sourced from the Deliberate Search and Reclassification of Maternal Deaths database, alongside other national databases. An algorithm was developed to extract the Robson Ten Group Classification System from clinical summaries text, facilitating a nuanced analysis of C-section rates. Information on the reasons for the performance of a C-section was also obtained. Logistic regression and multinomial logistic regression models were used to estimate the relation between obstetric risk factors, mode of delivery and causes of maternal death, adjusting for covariates.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Among maternal deaths in Mexico from 2010\u20132014, 47.1% underwent a C-section, with a significant history of previous C-sections observed in 31.4% of these cases, compared to 17.4% for vaginal deliveries (p&lt;0.001). Early prenatal care in the first trimester was more common in C-section cases (46.8%) than in vaginal deliveries (38.3%, p&lt;0.001). A stark contrast was noted in the place of death, with 82.4% of post-C-section deaths occurring in public institutions versus 69.1% following vaginal births. According to Robson\u2019s classification, the highest C-section rates were in Group 4 (67.2%, p&lt;0.001) and Group 8 (66.9%, p&lt;0.001). Logistic regression analysis revealed no significant difference in the odds of receiving a C-section in private versus other settings after adjusting for Robson criteria (OR: 1.21; 95% CI: 0.92, 1.60). A prior C-section significantly increased the likelihood of another (OR: 2.38; CI 95%: 2.01, 2.81). The analysis also indicated C-sections were significantly tied to deaths from hypertensive disorders (RRR = 1.25, 95% CI [1.12, 1.40]). In terms of indications, 6.3% of C-sections were performed under inadequate indications, while the indication was not identifiable in 33.1% of all C-sections.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This study highlights a significant overuse of C-sections among maternal deaths in Mexico (2010\u20132014), revealed through the Robson classification and ana analysis of the reported indications for the procedure. It underscores the need for revising clinical decision-making to promote evidence-based guidelines and favor vaginal deliveries when possible. High C-section rates, especially noted disparities between private and public sectors, suggest economic and non-clinical factors may be at play. The importance of accurate data systems and further research with control groups to understand C-section practices\u2019 impact on maternal health is emphasized.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0302369","type":"journal-article","created":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T17:33:41Z","timestamp":1715276021000},"page":"e0302369","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Obstetric risk profiles and causes of death: Estimating their association with cesarean sections among maternal deaths in Mexico"],"prefix":"10.1371","volume":"19","author":[{"given":"Pablo","family":"Mart\u00ednez-Garrido","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4157-5981","authenticated-orcid":true,"given":"Jimena","family":"Fritz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alejandra","family":"Montoya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mayra J.","family":"Garza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8775-8399","authenticated-orcid":true,"given":"H\u00e9ctor","family":"Lamadrid-Figueroa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,5,9]]},"reference":[{"key":"pone.0302369.ref001","first-page":"54","article-title":"Burden, Incidence, Mortality and Lethality of Maternal Disorders in Mexico 1990\u20132019: An Analysis for the Global Burden of Disease Study 2019: Archives of Medical Research 54 (2023) x\u2013x","author":"A Montoya","year":"2023","journal-title":"Arch Med Res"},{"key":"pone.0302369.ref002","unstructured":"Subsistema de Informacion de Nacimientos de la la Secretar\u00eda de Salud de M\u00e9xico. In: 2022 [Internet]. 2 May 2022 [cited 1 May 2023]. Available: http:\/\/www.dgis.salud.gob.mx\/contenidos\/sinais\/s_sinac.html."},{"key":"pone.0302369.ref003","article-title":"Unnecessary Cesarean Section Delivery Causes Risk to Both Mother and Baby: A Commentary on Pregnancy Complications and Women\u2019s Health","author":"Z Nahar","year":"2022","journal-title":"Inquiry (United States)"},{"key":"pone.0302369.ref004","first-page":"51","article-title":"Maternal complications and cesarean section without indication: systematic review and meta-analysis","author":"KC Mascarello","year":"2017","journal-title":"Rev Saude Publica"},{"key":"pone.0302369.ref005","article-title":"WHO statement on caesarean section rates","author":"AP Betran","year":"2016","journal-title":"BJOG: An International Journal of Obstetrics and Gynaecology"},{"key":"pone.0302369.ref006","unstructured":"World Health Organization. WHO recommendations on maternal and newborn care for a positive postnatal experience. World Health Organization; 2022."},{"key":"pone.0302369.ref007","first-page":"94","article-title":"Reclassifying causes of obstetric death in Mexico: a repeated cross-sectional study","author":"MC Hogan","year":"2016","journal-title":"Bull World Health Organ"},{"key":"pone.0302369.ref008","unstructured":"\u00cdndice de marginaci\u00f3n por entidad federativa y municipio 2010. Mexico City; 2011 Aug."},{"key":"pone.0302369.ref009","unstructured":"World Health Organization. 10th Revision of the International Classification of Diseases (ICD-10). WHO. 2012."},{"key":"pone.0302369.ref010","first-page":"10","article-title":"Translation from narrative text to standard codes variables with Stata","author":"F Belotti","year":"2010","journal-title":"Stata Journal"},{"key":"pone.0302369.ref011","first-page":"44","article-title":"Indications for Cesarean Delivery in Mexico: Evaluation of Appropriate Use and Justification","author":"JC Aranda-Neri","year":"2017","journal-title":"Birth"},{"key":"pone.0302369.ref012","first-page":"105","article-title":"Maternal death and caesarean section in South Africa: Results from the 2011\u20132013 saving mothers report of the national committee for confidential enquiries into maternal deaths","author":"GS Gebhardt","year":"2015","journal-title":"South African Medical Journal"},{"key":"pone.0302369.ref013","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1017\/S0965539501000122","article-title":"Classification of caesarean sections","volume":"12","author":"MS Robson","year":"2001","journal-title":"Fetal Matern Med Rev"},{"key":"pone.0302369.ref014","first-page":"17","article-title":"Analysis of caesarean section rates using the robson classification system at a university hospital in Spain","author":"R Vila-Candel","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0302369.ref015","first-page":"8","article-title":"Analysis of caesarean sections using Robson 10-group classification system in a university hospital in eastern Ethiopia: A cross-sectional study","author":"AK Tura","year":"2018","journal-title":"BMJ Open"},{"key":"pone.0302369.ref016","first-page":"1","article-title":"Office hours and caesarean section: systematic review and Meta-analysis","author":"I Hoxha","year":"2022","journal-title":"Research in Health Services & Regions"},{"key":"pone.0302369.ref017","article-title":"Explaining caesarean section in Salvador da Bahia, Brazil","author":"C. McCallum","year":"2005","journal-title":"Sociology of Health and Illness"},{"key":"pone.0302369.ref018","first-page":"97","article-title":"Trends of caesarean delivery from 2008 to 2017, mexico","author":"T Uribe-Leitz","year":"2019","journal-title":"Bull World Health Organ"},{"key":"pone.0302369.ref019","first-page":"120","article-title":"Obstetric outcome after intervention for severe fear of childbirth in nulliparous women \u2010 Randomised trial","author":"H Rouhe","year":"2013","journal-title":"BJOG"},{"key":"pone.0302369.ref020","first-page":"7","article-title":"Caesarean sections and for-profit status of hospitals: Systematic review and meta-analysis","author":"I Hoxha","year":"2017","journal-title":"BMJ Open"},{"key":"pone.0302369.ref021","first-page":"47","article-title":"Alone, I wouldn\u2019t have known what to do\u201d: A qualitative study on social support during labor and delivery in Mexico","author":"L Campero","year":"1998","journal-title":"Soc Sci Med"},{"key":"pone.0302369.ref022","first-page":"32","article-title":"Obstetrician\u2019s attitudes about delivery through cesarean section: A study in hospitals at Mexico City","author":"A Vallejos Par\u00e1s","year":"2018","journal-title":"Perinatol Reprod Hum"},{"key":"pone.0302369.ref023","first-page":"318","article-title":"Association between prepregnancy body mass index and severe maternal morbidity","author":"S Lisonkova","year":"2017","journal-title":"JAMA \u2010 Journal of the American Medical Association"},{"key":"pone.0302369.ref024","first-page":"9","article-title":"Trends in postpartum hemorrhage in high resource countries: A review and recommendations from the international postpartum hemorrhage collaborative group","author":"M Knight","year":"2009","journal-title":"BMC Pregnancy Childbirth"},{"key":"pone.0302369.ref025","first-page":"370","article-title":"Pregnancy and severity of infection","author":"AP Kourtis","year":"2014","journal-title":"N Engl J Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0302369","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T17:33:57Z","timestamp":1715276037000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0302369"}},"subtitle":[],"editor":[{"given":"Hlengani Lawrence","family":"Chauke","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,5,9]]},"references-count":25,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0302369","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,9]]}}}