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

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,...

Full description

Saved in:
Bibliographic Details
Published in:BMJ open 2022-04, Vol.12 (4), p.e055904
Main Authors: Ghosh, Rakesh, Santos, Nicole, Butrick, Elizabeth, Wanyoro, Anthony, Waiswa, Peter, Kim, Eliana, Walker, Dilys
Format: Article
Language:English
Subjects:
Birth weight
Cesarean Section
Cohort analysis
epidemiology
Female
Fetuses
Gestational age
Humans
Infant Mortality
Infant, Newborn
Kenya - epidemiology
Maternal Mortality
Newborn babies
Obstetrics
Obstetrics and Gynaecology
Pregnancy
Premature birth
Prospective Studies
quality in health care
Stillbirth
Stillbirth - epidemiology
Uganda - epidemiology
Vagina
Womens health
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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 number NCT03112018.
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2021-055904