Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study

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dc.contributor.authorDavid, Bishop
dc.contributor.authorRobert, A. Dyer
dc.contributor.authorMaswime, Salome
dc.contributor.authorReitze, N. Rodseth
dc.contributor.authorDominique, van Dyk
dc.contributor.authorHyla-Louise, Kluyts
dc.contributor.authorTumukunde, Janat T.
dc.contributor.authorMadzimbamuto, Farai D.
dc.contributor.authorAbdulaziz. M. Elkhogia
dc.contributor.authorNdonga, Andrew K. N.
dc.contributor.authorZipporah, W. W. Ngumi
dc.contributor.authorAkinyinka, O. Omigbodun
dc.contributor.authorSimbo, D. Amanor-Boadu
dc.contributor.authorEugene, Zoumenou
dc.contributor.authorApollo, Basenero
dc.contributor.authorDolly, M. Munlemvo
dc.contributor.authorCoulibaly, Youssouf
dc.contributor.authorNdayisaba, Gabriel
dc.contributor.authorAkwasi, Antwi-Kusi
dc.contributor.authorVeekash, Gobin
dc.contributor.authorPatrice, Forget
dc.contributor.authorMbwele, Bernard
dc.contributor.authorNdasi, Henry
dc.contributor.authorSylvia, R. Rakotoarison
dc.contributor.authorAhmadou, L. Samateh
dc.contributor.authorRyad, Mehyaoui
dc.contributor.authorUshmaben, Patel-Mujajati
dc.contributor.authorChaibou, M. Sani
dc.contributor.authorTonya, M. Esterhuizen
dc.contributor.authorThandinkosi, E. Madiba
dc.contributor.authorRupert, M. Pearse
dc.contributor.authorBruce, M. Biccard
dc.date.accessioned2025-03-31T16:16:22Z
dc.date.available2025-03-31T16:16:22Z
dc.date.issued2019
dc.description.abstractBackground Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. Methods A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. Findings Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2–2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3–0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2–18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46–13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99–17·34]) or anaesthesia complications (11·47 (1·20–109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7–5·0). Interpretation Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa.
dc.identifier.citationBishop, D., Dyer, R. A., Maswime, S., Rodseth, R. N., Van Dyk, D., Kluyts, H. L., ... & Assefa, S. B. (2019). Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study. The Lancet Global Health, 7(4), e513-e522.
dc.identifier.urihttps://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30036-1/fulltext
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/10259
dc.language.isoen
dc.publisherThe Lancet Global Health
dc.titleMaternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study
dc.typeArticle
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