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

BACKGROUND Caesarean delivery on maternal request (CDMR) is considered as a significant contributor to the unprecedented increase in the caesarean deliveries (CD) for non-clinical reasons. Current literature lacks a reliable assessment of the rate of CDMR, which hinders the planning and delivery of appropriate interventions for reducing the CDMR rates. OBJECTIVES Conduct a systematic review of literature and meta-regression to explore the global incidence of CDMR. SEARCH STRATEGY Pubmed, Embase, CINAHL, Medline, Google scholar and grey literature were searched from January 1985 to May 2019. SELECTION CRITERIA 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. DATA COLLECTION AND ANALYSIS 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 effect meta-regression was used to explain the variability of the CDMR estimates by moderators, including study methodology and demography of study participants. RESULTS We identified 31 articles from 14 countries that include 5 million total births. The absolute proportion of CDMR varies between 0.2% to 42% with significant variations across studies and sub-groups. The economic status of the country and study year both together explained 84% of absolute and 76% of the relative proportion of CDMR variations. CONCLUSIONS An appropriate reporting of CDMR should be a key priority in maternal health policies and practices.