Epidemiology and Outcomes of Caesarean Delivery

Cesarean delivery has become one of the most frequently performed surgical procedures worldwide, with rates rising steadily over the past three decades. This increase reflects a complex interplay of clinical, socioeconomic and infrastructural factors. Globally, average caesarean section (CS) rates range from under 5 percent in some low‐resource settings to over 40 percent in parts of Latin America and Asia. Within and between countries, striking variations are observed by region, facility type and maternal characteristics such as parity and age. Epidemiological data indicate that primary CS rates are often highest among nulliparous, term, singleton, vertex (NTSV) pregnancies, a key indicator cohort for quality of obstetric care. Contributory drivers include obstetric complications (for example, placenta praevia, fetal distress), elective maternal request, defensive medicine and uneven access to monitoring technologies. Short‐term maternal outcomes of caesarean delivery encompass surgical complications such as haemorrhage, infection and anaesthetic adverse events. Newborn outcomes may include altered respiratory adaptation, admission to neonatal intensive care and, in some contexts, increased neonatal mortality. In the longer term, women undergoing caesarean delivery face elevated risks of pelvic floor dysfunction, placental abnormalities in subsequent pregnancies and fertility implications. Children born by CS have been associated with differences in immunological development, with modestly increased risks of asthma and early childhood obesity. Effective classification systems, notably the Robson ten‐group scheme, facilitate comparison of CS rates and provide a framework for audit and policy interventions. Emphasis has shifted towards evidence‐based guidelines, smart intrapartum surveillance and targeted quality improvement programmes aimed at optimising CS use while safeguarding maternal and neonatal health.

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Epidemiology and Outcomes of Caesarean Delivery publication trend

The graph below shows the total number of articles in epidemiology and outcomes of caesarean delivery across all publications each year (not limited to Nature Index journals).

Technical terms

NTSV (nulliparous, term, singleton, vertex): A low-risk obstetric cohort used to monitor primary CS rates.

Robson classification: A ten-group system that categorises pregnant women by obstetric characteristics to compare CS rates.

Induction of labour: Medical initiation of uterine contractions before spontaneous onset to achieve vaginal birth.

Peripartum haemorrhage: Excessive bleeding occurring around the time of childbirth.

Apgar score: A rapid assessment of neonatal health at 1 and 5 minutes, based on appearance, pulse, grimace, activity and respiration.

References

1. Reducing primary cesarean delivery rate through implementation of a smart intrapartum surveillance system. npj Digital Medicine (2023).
2. Induction of labour at 39 weeks and adverse outcomes in low-risk pregnancies according to ethnicity, socioeconomic deprivation, and parity: A national cohort study in England. PLOS Medicine (2023).
3. Trends and projections of caesarean section rates: global and regional estimates. BMJ Global Health (2021).