Maternal and Perinatal Mortality and Complications Associated With Caesarean Section in Low-income and Middle-income Countries: A Systematic Review and Meta-Analysis

Sobhy, Soha; Arroyo-Manzano, D.; Murugesu, Nilaani; Karthikeyan, Gayathri; Kumar, Vinay; Kaur, Inderjeet; Fernández, Eduardo J.; Gundabattula, Sirisha Rao; Betrán, Ana Pilar; Khan, Khalid S.; Zamora, Javier; Thangaratinam, Shakila

doi:10.1097/01.aoa.0000652820.07964.a2

Cited by 46 publications

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“…This is comparable with findings of a systematic review and meta-analysis conducted in low-and middleincome countries where the risk of maternal death in women who had CS was 7.6 per 1000 women (10.9 per 1000 women in sub-Saharan Africa) [46]. Although the risk of maternal death is usually higher after CS than after vaginal birth both in low [46] and high income [11,47] countries, the magnitude was greater in our study than in most previous studies. This may be because this study included only hospitals with data where complicated cases are managed while vaginal births can be provided at lower level facilities.…”

Section: Discussionsupporting

confidence: 86%

Association between maternal mortality and caesarean section in Ethiopia: a national cross-sectional study

Chojenta

Taddele

Loxton

2020

BMC Pregnancy Childbirth

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Background Several studies concluded that there is a reduction of maternal deaths with improved access to caesarean section, while other studies showed the existence of a direct association between the two variables. In Ethiopia, literature about the association between maternal mortality and caesarean section is scarce. This study was aimed to assess the association between maternal mortality ratios and caesarean section rates in hospitals in Ethiopia. Methods Analysis was done of a national maternal health dataset of 293 hospitals that accessed from the Ethiopian Public Health Institute. Hospital specific characteristics, maternal mortality ratios and caesarean section rates were described. Pearson’s correlation coefficient was used to determine the direction of association between maternal mortality ratios and caesarean section rate, taking regions into consideration. Presence of a linear association between these variables was declared statistically significant at p-value < 0.05. Results The overall maternal mortality ratio in Ethiopian hospitals was 149 (95% CI: 136–162) per 100,000 livebirths. There was significant regional variation in maternal mortality ratios, ranging from 74 (95% CI: 51–104) per 100,000 livebirths in Tigray region to 548 (95% CI: 251-1,037) in Afar region. The average annual caesarean section rate in hospitals was 20.3% (95% CI: 20.2–20.5). The highest caesarean section rate of 38.5% (95% CI: 38.1–38.9) was observed in Addis Ababa, while the lowest rate of 5.7% (95% CI: 5.2–6.2) occurred in Somali region. At national level, a statistically non-significant inverse association was observed between maternal mortality ratios and caesarean section rates. Similarly, unlike in other regions, there were inverse associations between maternal mortality ratios and caesarean section rates in Addis Ababa, Afar Oromia and Somali, although associations were not statistically significant. Conclusions At national level, a statistically non-significant inverse association was observed between maternal mortality ratios and caesarean section rates in hospitals, although there were regional variations. Additional studies with a stronger design should be conducted to assess the association between population-based maternal mortality ratios and caesarean section rates.

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Section: Discussionsupporting

confidence: 86%

Association between maternal mortality and caesarean section in Ethiopia: a national cross-sectional study

Chojenta

Taddele

Loxton

2020

BMC Pregnancy Childbirth

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“…The result is consistent with studies conducted in Sudan (17) and Pakistan (43). This might be due most C/S deliveries done by emergency after labor complication and fetal distress that increased the risk of neonatal morbidity and mortality (44).…”

Section: Multilevel Logistic Regression Analysissupporting

confidence: 91%

Spatial Distribution and Associated Factors of Neonatal Mortality in Ethiopia: using Ethiopian Demographic and Health Survey 2016

Deres¹,

Teshome²,

Lakew³

2020

Preprint

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Background: Neonatal mortality is continuing on top of the agenda of public health and international development agencies. In Ethiopia, it is still high accounts 60% infant mortality and 43% of under-five mortality. However, the distribution of the problem across the regions of Ethiopia is not well addressed. Therefore, this analysis aimed to assess spatial distribution of neonatal mortality and identify associated factors in Ethiopia using the 2016 Ethiopian Demographic Health Survey (EDHS). Exploring spatial distribution and identifying associated factors is important to select priority areas and design effective intervention program to reduce neonatal mortality. Methods: The analysis included 7,193 live births, selected by stratified two-stage cluster sampling techniques. Spatial analysis was done to explore spatial distribution of neonatal death using Geographic information system and Sat scan. Multilevel logistic regression was fitted to identify individual and community level factors associate with neonatal mortality. Results: The hot-spot areas for neonatal mortality were Amhara, West Tigray, northeast, southwest and central part of Oromia. Mother’s with age >35 years (AOR=2.25, 95CI%: 1.47, 3.45), family size of 3-5 (AOR=0.14, 95CI%: 0.06, 0.36) and 6 and above (AOR=0.08, 95%CI: 0.02, 0.20), male neonates (AOR=3.45, 95%CI: 2.27, 5.22), smaller birth size (AOR=1.61, 95%CI: 1.02, 2.54), birth interval less than 2 years (AOR=3.58, 95%CI: 1.66, 7.70) and 2 years and more (AOR=2.54, 95%CI: 1.26-5.11), early initiation of breast feeding (AOR=0.20, 95%CI: 0.09-0.42), had no ANC visit (AOR=1.68, 95%CI: 1.08, 2.60), did not receive PNC services (AOR=3.58, 95%CI: 1.13 -11.33) and C/S delivery (AOR=19.55, 95%CI: 8.07, 47.34) were statistically significant variables for neonatal mortality. Conclusions: High risk areas for neonatal mortality were identified in northern, central and southwest part of the Ethiopia. Individual level variables were important factors associated with neonatal mortality. Focusing on maternal health care services, increase birth interval and initiation of breast feeding early will be needed to reduce neonatal mortality.

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“…In low-income countries (LICs), both the risks of TOL as well as the risks of repeat CS are increased compared to high-income countries [5][6][7][8]. Maternal mortality after CS in Africa is 50 times higher than in high-income countries (HICs), mostly due to anaesthesia complications and haemorrhage [9,10]. The most feared complication of TOL is uterine rupture (UR), which occurs in 0.47% of women who have a TOL [11].…”

Section: Introductionmentioning

confidence: 99%

Association between surgical technique, adhesions and morbidity in women with repeat caesarean section: a retrospective study in a rural hospital in Western Tanzania

Mooij

Mwampagatwa

Dillen

et al. 2020

BMC Pregnancy Childbirth

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Background The worldwide incidence of birth by Caesarean Section (CS) is rising. Many births after a previous CS are by repeat surgery, either by an elective CS or after a failed trial of labour. Adhesion formation is associated with increased maternal morbidity in patients with repeat CSs. In spite of large-scale studies the relation between the incidence of adhesion formation and CS surgical technique is unclear. This study aims to assess maternal and neonatal morbidity and mortality after repeat CSs in a rural hospital in a low-income country (LIC) and to analyse the effect of surgical technique on the formation of adhesions. Methods A cross-sectional, retrospective medical records study of all women undergoing CS in Ndala Hospital in 2011 and 2012. Results Of the 3966 births, 450 were by CS (11.3%), of which 321 were 1st CS, 80 2nd CS, 36 3rd CS, 12 4th and one 5th CS (71, 18, 8, 3 and 0.2% respectively). Adhesions were considered to be severe in 56% of second CSs and 64% of third CSs. In 2nd CSs, adhesions were not associated with closure of the peritoneum at 1st CS, but were associated with the prior use of a midline skin incision. There was no increase in maternal morbidity when severe adhesions were present. Adverse neonatal outcome was more prevalent when severe adhesions were present, but this was statistically non-significant (16% vs 6%). Conclusions Our results give insight into the practice of repeat CS in our rural hospital. Adhesions after CSs are common and occur more frequently after midline skin incision at 1st CS compared to a transverse incision. Reviewing local data is important to evaluate quality of care and to compare local outcomes to the literature.

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Maternal and Perinatal Mortality and Complications Associated With Caesarean Section in Low-income and Middle-income Countries: A Systematic Review and Meta-Analysis

Cited by 46 publications

References 0 publications

Association between maternal mortality and caesarean section in Ethiopia: a national cross-sectional study

Association between maternal mortality and caesarean section in Ethiopia: a national cross-sectional study

Spatial Distribution and Associated Factors of Neonatal Mortality in Ethiopia: using Ethiopian Demographic and Health Survey 2016

Association between surgical technique, adhesions and morbidity in women with repeat caesarean section: a retrospective study in a rural hospital in Western Tanzania

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