The effect of anaesthesia and antenatal care on feto-maternal outcome after caesarean section in a developing country (original) (raw)
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BMC Research Notes, 2015
Background: Elective caesarean sections (ECS) have been implicated in increased risk of adverse neonatal outcomes. The primary objective was to assess the incidence and determinants of neonatal morbidity after elective caesarean section deliveries. The secondary objective was to describe the maternal morbidity associated with elective caesarean section. Methods: This was a prospective cohort study of women admitted for ECS, as well as their newborns, conducted at Mulago hospital from March 1, 2013 to February 28, 2014. These were followed from the time of the operation until 6 weeks after hospitalization following the caesarean delivery. Data was collected using an interviewer-administered questionnaire and review of medical records for demographic characteristics, obstetric history, current pregnancy complications and pregnancy outcomes up to hospital discharge. Study outcomes were maternal and neonatal morbidity. The data was analyzed using Stata version 12. Results: There were 25,846 deliveries during the study period, of which 20,083 (77.7 %) were vaginal deliveries or assisted deliveries, and 5763 (22.3 %) were caesarean sections. Of the caesarean sections, 920 (15.9 %) were ECS. The commonest maternal morbidity was hemorrhage (17.2 %). A birth weight less than 2500 g (aRR 11.0 [95 % CI 8.1-17.2]) or more than 4000 g (aRR 12.2 [95 % CI 10.6-23.2]), delivery at gestation age less than or equal to 38 weeks (aRR 1.62 [95 % 1.20-2.10]), multigravidity (aRR 1.70 [95 % CI 1.20-2.90]) and using general anaesthesia (aRR 2.43 [95 % CI 1.20-5.90]) were associated with risk of neonatal morbidity. The commonest neonatal morbidity is respiratory distress especially if delivery occurs at a gestation age of 37 weeks or lower, if the birth weight is less than 2500 g or more than 4000 g, and if general anesthesia is used. Conclusion: Our study shows that at Mulago Hospital, ECS is associated with significant neonatal and maternal morbidity. We recommend that elective caesarean sections be performed after 39 weeks of gestation, and preferably avoid using general anaesthesia.
International Journal of Nursing and Midwifery, 2018
Anesthetic management of preeclamptic patients remains a challenge. Although general anesthesia can be used safely in pre-eclamptic women, it is fraught with greater maternal morbidity and mortality. The added risks associated with general anesthesia include airway difficulties due to edema (often aggravated by tracheal intubation) and the pressure response to laryngoscope and intubation. However, several studies support the use of spinal anesthesia as first choice reasoning less postoperative morbidity and mortality. To compare maternal outcome among preeclamptic women after caesarian delivery under general and spinal anesthesia in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Hospital based retrospective comparative cross sectional study was used to compare maternal outcomes. All preeclamptic mothers that underwent Caesarian Section in Obstetrics and Gynecology Ward, Tikur Anbessa Specialized Hospital from October 2014 to October 2016 was included in the study. Data collection was carried out by using structured questionnaire. Data entry and analysis was done on SPSS version 20. Independent sample T-test and logistic regression was conducted to compare the outcome in both groups of spinal and general anesthesia, 95% confidence interval (CI) and p value < 0.05 is set as cut off point for statistical significance. The mean age of study subjects were 28.18 years and SD= ± 4.66 years, the median age is 28 years (IQR: 25-30 years). Majority 152 (91%) of the cesarean sections (C/S) was emergency C/S and the rest 15 (9%) were elective C/S. 78 (46.7%) of parturient operated under general anesthesia, and 89 (53.3%) were operated under spinal anesthesia. None of the mothers developed post-op complication, and none of the maternal death were documented until discharge from the hospital in both groups of parturient. The present finding shows that statistically significant higher intra operative blood pressure and pulse rate was observed among GA group when compared with SA group. In conclusion, SA is safer than GA in terms of stable intra operative vital signs among preeclamptic women.
Feto-maternal outcomes of caesarean delivery in Federal Medical Centre, Asaba: a two year review
African Health Sciences
Background: The upward trend of caesarean section and its associated morbidity/mortality especially in low and middle income areas makes regular appraisal of the procedure necessary. Objective: To evaluate caesarean section; its rate, indications, and maternal and fetal outcomes in Asaba. Methods: A retrospective study of all caesarean sections carried out at the obstetrics unit of the Federal Medical Centre, Asaba, between July 1, 2018 and June 31, 2020. Data was analyzed using SPSS version 20. Results: There were 2778 deliveries during the period, out of which 705 had caesarean sections, giving an overall caesarean section rate of 25.4%.There were 456 (64.7%) emergency caesarean sections. The commonest indication for caesarean section was repeat caesarean section 196 (27.8%), while cephalo-pelvic disproportion 87 (12.3%) was the commonest indication for emergency caesarean section. Majority of the babies had low APGAR score at 1min and 5mins, 126 (27.6%) and 50 (11.0%) from emerge...
Maternal Deaths During Caesarean Delivery In A Developing Country-Perspective From Nigeria
The Internet Journal of Third World Medicine, 2009
OBJECTIVE: To examine the changing trend in maternal deaths during caesarean delivery in a tertiary care hospital in Nigeria over an 8 year periodMATERIALS/ METHODS:An observational retrospective study was carried out at the University of Nigeria Teaching Hospital (UNTH), Nigeria to determine the causes and risk factors for maternal deaths during caesarean delivery from July 1998 to June 2006. RESULTS: A total of 6798 women delivered during the study period. There were 1579 caesarean sections (23% caesarean section rate).There were nine documented deaths during the course of anaesthesia and surgery to given an incidence of 5.6/1000 anesthetics. Six deaths were directly attributable to anaesthesia, three were indirectly attributable. CONCLUSION: The number of maternal deaths in this study was initially high. Since the increased use of spinal anaesthesia and employment of more doctors, the rates have dropped drastically.
Background: Types of anesthesia and perioperative patient cares are the main determinants of maternal and neonatal outcomes in mothers undergo caesarean section. Body of evidence revealed that maternal and neonatal outcomes were better in mothers who gave birth under spinal anesthesia than general anesthesia. However evidences are lacking locally, hence, this study aimed to compare maternal and neonatal outcomes in mothers who undergo caesarean section under general anesthesia and spinal anesthesia. Methods: a prospective Cohort study was conducted in Gandhi Memorial Hospital among mothers, who undergo cesarean section under spinal and general anesthesia from March to July, 2014. One hundred and twenty Mothers were followed for twenty four hours period. Statistical Package for Social Sciences version 16 was used to perform descriptive and logistic regression analyses. Statistical significance was set at P-value <0.05 to judge the association. Results: The total response rate of the study was 120 (100 %). The study revealed that types of anesthesia were independent predictor of maternal and neonatal outcomes. Mothers who underwent caesarean section under spinal were more likely to have postoperative nausea and vomiting (COR= 38.5, 95% CI= (12,123). Incidence of low Apgar score in first minute was two and half times more likely to occur in general anesthesia, (AOR=2.54, 95% CI= (1.26, 25.4). The first analgesic request in mothers underwent caesarean section under spinal anesthesia was three times more than mothers underwent caesarean section under general anesthesia (AOR=3.4, 95%CI= (1.4, 6.7) Conclusion: Spinal anesthesia was associated with high incidence of postoperative nausea and vomiting and hypotension. But first minute Apgar score and first time analgesic request were better in spinal analgesia. General anesthesia was associated with high estimated blood loss, shorter time to first analgesic request and lower first minute Apgar score. Appropriate perioperative patient care by anesthetist and provision of drugs for treatment of hypotension were recommended.
Caesarean Section and Perinatal Outcome in a Sub-urban Tertiary Hospital in Northwest Nigeria
Nepal Journal of Obstetrics and Gynaecology, 2016
Aims: This study was undertaken to review the caesarean section rate and perinatal mortality in Federal Medical Centre, Birnin Kudu from 1 January 2010 to 31 December 2012. 0HWKRGV 7KLV ZDV D UHWURVSHFWLYH VWXG\ LQYROYLQJ UHYLHZ RI FDVH ¿OHV (WKLFDO FOHDUDQFH ZDV REWDLQHG 7KH UHFRUGV RI labour ward, neonatal intensive care unit and operating theatre were use. Information extracted includes age, parity, booking status, total deliveries, indications for caesarean section and perinatal outcome from 1st January 2010 to 31st December DW)HGHUDO 0HGLFDO &HQWUH %LUQLQ .XGX 7KH GDWD REWDLQHG ZDV DQDO\]HG XVLQJ 6366 YHUVLRQ VWDWLVWLFDO VRIWZDUH (Chicago). Absolute numbers and simple percentages were used to describe categorical variables. Results: A total of 590 caesarean sections were done which is rate of 17.69%. Of the 590 caesarean deliveries, 580 case notes ZHUH UHWULHYHG JLYLQJ D UHWULHYDO UDWH RI $ WRWDO RI RXW RI EDELHV GLHG ZLWKLQ WKH ¿UVW RQH ZHHN RI FDHVDUHDQ delivery, giving a perinatal mortality rate of 17.4 per 1000. The average age of the women was 25.9±6.2 years. Majority of them were uneducated and unemployed. Obstructed labour was the most common indication for emergency caesarean section accounting for 31.7% of caesarean sections followed by pre-eclampsia/eclampsia. Conclusions: Caesarean section rate in the present study is comparatively high and perinatal mortality is low but it is unclear if there is a correlation between caesarean section rate and perinatal mortality. This needs further studies. .H\ZRUGV caesarean section; Northwest Nigeria; perinatal outcomes.
The Australian and New Zealand Journal of Obstetrics and Gynaecology, 2007
Data about maternal outcomes of elective Caesarean section in low-income countries are limited. To estimate the maternal morbidity and mortality associated with elective Caesarean delivery at a Nigerian University hospital. Retrospective analysis of all elective Caesarean deliveries at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria (1990-2005). For each case of elective Caesarean delivery, four parturients who achieved non-operative vaginal delivery following spontaneous onset of labour were selected to serve as a referent group. Morbidity outcomes and mortality among women who had elective Caesarean delivery were compared with those of the referent group to estimate their comparative risks. Level of significance was put at P&amp;amp;amp;lt;0.05. A total of 164 elective Caesarean sections were performed out of 6882 deliveries (2.4%). All morbidities were more frequent among women who had elective Caesarean section compared to those who had vaginal delivery but only peripartum blood transfusion (11.6 vs 5.6%), puerperal febrile morbidity (11.0 vs 4.7%), unplanned readmission (4.3 vs 1.4%), mean fall in haemoglobin concentration (1.5 +/- 0.6 vs 0.5 +/- 0.7 g/dL) and mean hospital stay (13.3 +/- 8.8 vs 6.2 +/- 5.4 days) showed statistically significant differences. There was one maternal death among the elective Caesarean section group, giving a maternal mortality ratio of 6.1:1000 deliveries, which was not significantly different from 3.0:1000 deliveries in the referent group. Elective Caesarean delivery in this hospital is certainly accompanied by considerable maternal risks and should be offered to pregnant women with extreme caution. Efforts should be made to improve its safety by investigating and rectifying the factors responsible for the associated severe maternal complications.
Caesarean section--an appraisal of some predictive factors in Lagos Nigeria
BMC pregnancy and childbirth, 2014
Several maternity units in the developing world lack facilities for caesarean section and often have to transfer patients in extremis. This case controlled study aimed to appraise predictive factors for caesarean section. One hundred and fifty two consecutive women with singleton pregnancies who had caesarean section were studied. The next parturient with normal delivery served as control. Variables such as age, parity, marital status, booking status, past obstetric history, weight, height, infant birth weight were assessed. Data obtained were analysed using SPSS 16.0 Windows package. During the study period, there were 641 deliveries with 257 of them by caesarean section (40.1%).Logistic regression analysis showed that parity, booking status, maternal height; maternal weight, birth weight, previous caesarean section and ante-partum bleeding were significant predictive factors for caesarean section while maternal age was not. These predictive factors should be considered in antenata...
Caesarean section and perinatal outcomes in a sub-urban tertiary hospital in North-West Nigeria
Nigerian medical journal : journal of the Nigeria Medical Association
This study was undertaken to review the caesarean section rate and perinatal mortality in Federal Medical Centre, Birnin Kudu from 1(st) January 2010 to 31st December, 2012. This was a retrospective study involving review of 580 case files. Ethical clearance was obtained. The records of labour ward, neonatal intensive care unit (ICU) and operating theatre were use. Information extracted includes age, parity, booking status, total deliveries, indications for caesarean section and perinatal outcome from 1(st) January 2010 to 31(st) December 2012 at Federal Medical Centre, Birnin Kudu. The data obtained was analysed using SPSS version 17.0 statistical software (Chicago, Il, USA). Absolute numbers and simple percentages were used to describe categorical variables. Association between caesarean section and perinatal mortality was determined using Pearson's Coefficient of correlation and student t- test. P - value < 0.05 was considered statistically significant. This study reported...