Perinatal outcomes of cesarean deliveries in Sierra Leone: A prospective multicenter observational study

Duinen, Alex J. van; Westendorp, Josien; Kamara, Michael; Forna, Fatu; Hagander, Lars; Rijken, Marcus J.; Leather, Andrew J M; Wibe, Arne; Bolkan, Håkon Angell

doi:10.1002/ijgo.13172

Cited by 4 publications

(5 citation statements)

References 21 publications

(43 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Delayed and substandard care results in a perinatal mortality rate after caesarean section of 190 per 1000 births, 18 much higher than the national perinatal mortality rate of 39 per 1000 pregnancies. 23…”

Section: Methodsmentioning

confidence: 99%

Travel time and perinatal mortality after emergency caesarean sections: an evaluation of the 2-hour proximity indicator in Sierra Leone

et al. 2020

Self Cite

View full text Add to dashboard Cite

IntroductionLonger travel times are associated with increased adverse maternal and perinatal outcomes. Geospatial modelling has been increasingly used to estimate geographic proximity in emergency obstetric care. In this study, we aimed to assess the correlation between modelled and patient-reported travel times and to evaluate its clinical relevance.MethodsWomen who delivered by caesarean section in nine hospitals were followed up with home visits at 1 month and 1 year. Travel times between the location before the delivery and the facility where caesarean section was performed were estimated, based on two models (model I Ouma et al; model II Munoz et al). Patient-reported and modelled travel times were compared applying a univariable linear regression analysis, and the relation between travel time and perinatal mortality was assessed.ResultsThe median reported travel time was 60 min, compared with 13 and 34 min estimated by the two models, respectively. The 2-hour access threshold correlated with a patient-reported travel time of 5.7 hours for model I and 1.8 hours for model II. Longer travel times were associated with transport by boat and ambulance, visiting one or two facilities before reaching the final facility, lower education and poverty. Lower perinatal mortality was found both in the group with a reported travel time of 2 hours or less (193 vs 308 per 1000 births, p<0.001) and a modelled travel time of 2 hours or less (model I: 209 vs 344 per 1000 births, p=0.003; model II: 181 vs 319 per 1000 births, p<0.001).ConclusionThe standard model, used to estimate geographical proximity, consistently underestimated the travel time. However, the conservative travel time model corresponded better to patient-reported travel times. The 2-hour threshold as determined by the Lancet Commission on Global Surgery, is clinically relevant with respect to reducing perinatal death, not a clear cut-off.

show abstract

Section: Methodsmentioning

confidence: 99%

Travel time and perinatal mortality after emergency caesarean sections: an evaluation of the 2-hour proximity indicator in Sierra Leone

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…We observed a high incidence of adverse perinatal outcome after 2 nd CSs (12%). This might reflect the high general perinatal mortality rate in emergency CSs in a low-resource setting, which has been reported to be up to 19% [26]. In our hospital the perinatal mortality in 1 st CSs is unknown.…”

Section: Discussionmentioning

confidence: 76%

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

View full text Add to dashboard Cite

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.

show abstract

“…Increased CS rates among referred-in mothers could contribute to higher rates of stillbirths30 31 and maternal deaths,26 due to delays in transportation, timeliness, etc. However, we were intrigued to note that referred-in mothers had a lower risk of stillbirth and maternal death, though the latter was not significant.…”

Section: Discussionmentioning

confidence: 99%

Stillbirth, neonatal and maternal mortality among caesarean births in Kenya and Uganda: a register-based prospective cohort study

et al. 2022

View full text Add to dashboard Cite

ObjectiveTo investigate the interaction of risks for adverse maternal and perinatal outcomes (stillbirth, predischarge neonatal and maternal mortality) among caesarean section (CS) compared with vaginal deliveries (VD).DesignProspective cohort study.Setting10 CS-capable facilities in Busoga Region, East-Central Uganda and Migori County, Kenya.ParticipantsIndividual birth data were extracted from maternity registers between October 2016 and April 2019. There were a total of 77 242 livebirths and 3734 stillbirths. Overall, 24% of deliveries were by CS with a range of 9%–49% across facilities.Primary outcome measuresStillbirth, predischarge neonatal mortality and maternal mortality.ResultsThe adjusted ORs for stillbirth, predischarge neonatal mortality and maternal mortality after a CS were 1.3 (95% CI 1.1 to 1.6), 1.9 (95% CI 1.6 to 2.2) and 3.3 (95% CI 2.2 to 4.9), respectively, compared with a VD. The association between maternal mortality and CS was 3.9 (95% CI 2.8 to 5.5) when the delivery was a live birth and 1.7 (95% CI 1.0 to 3.0) when it was a stillbirth. Post hoc analyses showed that mothers who received a CS had a lower risk of stillbirth if they were documented as a referral.ConclusionIn this context, CS births were at higher risk for worse outcomes compared with VD. Better understanding of CS use and associated adverse outcomes within the mother–baby dyad is necessary to identify opportunities to improve quality of intrapartum care.Trial registration numberNCT03112018.

show abstract

Perinatal outcomes of cesarean deliveries in Sierra Leone: A prospective multicenter observational study

Cited by 4 publications

References 21 publications

Travel time and perinatal mortality after emergency caesarean sections: an evaluation of the 2-hour proximity indicator in Sierra Leone

Travel time and perinatal mortality after emergency caesarean sections: an evaluation of the 2-hour proximity indicator in Sierra Leone

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

Stillbirth, neonatal and maternal mortality among caesarean births in Kenya and Uganda: a register-based prospective cohort study

Contact Info

Product

Resources

About