Global incidence of caesarean deliveries on maternal request: a systematic review and meta-regression.

Abstract

Caesarean delivery on maternal request (CDMR) is considered a significant contributor to the unprecedented increase in caesarean deliveries (CDs) for nonclinical reasons. Current literature lacks a reliable assessment of the rate of CDMR, which hinders the planning and delivery of appropriate interventions for reducing CDMR rates. To conduct a systematic review of the literature and meta-regression to explore the global incidence of CDMR. PubMed, Embase, CINAHL, Medline, Google scholar and grey literature were searched from January 1985 to May 2019. Observational studies that report CDMR data were included. We excluded non-English articles, case notes, editorial reviews and articles reporting elective CDs from pregnancy risk factors. Two reviewers independently conducted the screening and quality appraisal using a validated tool. The weighted average of CDMR over total deliveries (absolute proportion) and by total CDs (relative proportion) were generated. Quality-effects meta-regression was used to explain the variability of the CDMR estimates by moderators, including study methodology and demography of study participants. We identified 31 articles from 14 countries that include 5 million total births. The absolute proportion of CDMR varies between 0.2 and 42.0%, with significant variations across studies and subgroups. The economic status of the country and study year together explained 84% of the absolute and 76% of the relative proportion of CDMR variation. An appropriate reporting of CDMR should be a key priority in maternal health policies and practices. Globally, the proportion of maternal requested caesarean delivery has mostly been influenced by the economic status of the country.