Alex J van Duinen1,2, Josien Westendorp1,3, Michael M Kamara4,5, Fatu Forna6, Lars Hagander7, Marcus J Rijken3,8, Andrew J M Leather9, Arne Wibe1,2, Håkon A Bolkan1,2. 1. Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway. 2. Department of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway. 3. University Medical Centre Utrecht, Utrecht, The Netherlands. 4. Ministry of Health and Sanitation, Freetown, Sierra Leone. 5. College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone. 6. World Health Organization, Freetown, Sierra Leone. 7. Surgery and Public Health, Department of Clinical Sciences Lund, Faculty of Medicine, Skane University Hospital, Lund University, Lund, Sweden. 8. The Julius Centre for Health Sciences and Primary Care, Utrecht, The Netherlands. 9. King's Centre for Global Health and Health Partnerships, King's College London, London, UK.
Abstract
OBJECTIVE: To analyze the indications for cesarean deliveries and factors associated with adverse perinatal outcomes in Sierra Leone. METHODS: Between October 2016 and May 2017, patients undergoing cesarean delivery performed by medical doctors and associate clinicians in nine hospitals were included in a prospective observational study. Data were collected perioperatively, at discharge, and during home visits after 30 days. RESULTS: In total, 1274 cesarean deliveries were included of which 1099 (86.3%) were performed as emergency surgery. Of the 1376 babies, 261 (19.0%) were perinatal deaths (53 antepartum stillbirths, 155 intrapartum stillbirths, and 53 early neonatal deaths). Indications with the highest perinatal mortality were uterine rupture (45 of 55 [81.8%]), abruptio placentae (61 of 85 [71.8%]), and antepartum hemorrhage (8 of 15 [53.3%]). In the group with cesarean deliveries performed for obstructed and prolonged labor, a partograph was filled out for 212 of 425 (49.9%). However, when completed, babies had 1.81-fold reduced odds for perinatal death (95% confidence interval 1.03-3.18, P-value 0.041). CONCLUSION: Cesarean deliveries in Sierra Leone are associated with an exceptionally high perinatal mortality rate of 190 per 1000 births. Late presentation in the facilities and lack of adequate fetal monitoring may be contributing factors.
OBJECTIVE: To analyze the indications for cesarean deliveries and factors associated with adverse perinatal outcomes in Sierra Leone. METHODS: Between October 2016 and May 2017, patients undergoing cesarean delivery performed by medical doctors and associate clinicians in nine hospitals were included in a prospective observational study. Data were collected perioperatively, at discharge, and during home visits after 30 days. RESULTS: In total, 1274 cesarean deliveries were included of which 1099 (86.3%) were performed as emergency surgery. Of the 1376 babies, 261 (19.0%) were perinatal deaths (53 antepartum stillbirths, 155 intrapartum stillbirths, and 53 early neonatal deaths). Indications with the highest perinatal mortality were uterine rupture (45 of 55 [81.8%]), abruptio placentae (61 of 85 [71.8%]), and antepartum hemorrhage (8 of 15 [53.3%]). In the group with cesarean deliveries performed for obstructed and prolonged labor, a partograph was filled out for 212 of 425 (49.9%). However, when completed, babies had 1.81-fold reduced odds for perinatal death (95% confidence interval 1.03-3.18, P-value 0.041). CONCLUSION: Cesarean deliveries in Sierra Leone are associated with an exceptionally high perinatal mortality rate of 190 per 1000 births. Late presentation in the facilities and lack of adequate fetal monitoring may be contributing factors.
Authors: Alex J van Duinen; Håvard A Adde; Ola Fredin; Hampus Holmer; Lars Hagander; Alimamy P Koroma; Michael M Koroma; Andrew Jm Leather; Arne Wibe; Håkon A Bolkan Journal: BMJ Glob Health Date: 2020-12