Maternal mortality and cesarean delivery: An analytical observational study

Kamilya, Gourisankar; Seal, Subrata Lall; Mukherji, Joydev; Bhattacharyya, S.K.; Hazra, Avijit

doi:10.1111/j.1447-0756.2009.01125.x

Cited by 33 publications

(42 citation statements)

References 14 publications

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“…This method allowed us to assess the excess maternal and neonatal mortality risks related to CS in all the patients except very high risk women, and to provide results which could be generalizable to all women delivering in referral hospitals in similar contexts without life threatening maternal and fetal compromise. Furthering this approach, we performed a sensitivity analysis including only low-risk women (i.e., with no identifiable medical risk factors) as proposed by authors from more developed countries [2], [3], [17], [18], and we obtained similar results. We did not have information available for congenital malformations and anomalies, which are known to be associated with poor perinatal outcomes.…”

Section: Discussionmentioning

confidence: 63%

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Maternal and Perinatal Outcomes by Mode of Delivery in Senegal and Mali: A Cross-Sectional Epidemiological Survey

et al. 2012

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ObjectiveIn the context of rapid changes regarding practices related to delivery in Africa, we assessed maternal and perinatal adverse outcomes associated with the mode of delivery in 41 referral hospitals of Mali and Senegal.Study DesignCross-sectional survey nested in a randomised cluster trial (1/10/2007–1/10/2008). The associations between intended mode of delivery and (i) in-hospital maternal mortality, (ii) maternal morbidity (transfusion or hysterectomy), (iii) stillbirth or neonatal death before Day 1 and (iv) neonatal death between 24 hours after birth and hospital discharge were examined. We excluded women with immediate life threatening maternal or fetal complication to avoid indication bias. The analyses were performed using hierarchical logistic mixed models with random intercept and were adjusted for women's, newborn's and hospitals' characteristics.ResultsAmong the 78,166 included women, 2.2% had a pre-labor cesarean section (CS) and 97.8% had a trial of labor. Among women with a trial of labor, 87.5% delivered vaginally and 12.5% had intrapartum CS. Pre-labor CS was associated with a marked reduction in the risk of stillbirth or neonatal death before Day 1 as compared with trial of labor (OR = 0.2 [0.16–0.36]), though we did not show that maternal mortality (OR = 0.3 [0.07–1.32]) and neonatal mortality after Day 1 (OR = 1.3 (0.66–2.72]) differed significantly between groups. Among women with trial of labor, intrapartum CS and operative vaginal delivery were associated with higher risks of maternal mortality and morbidity, and neonatal mortality after Day 1, as compared with spontaneous vaginal delivery.ConclusionsIn referral hospitals of Mali and Senegal, pre-labor CS is a safe procedure although intrapartum CS and operative vaginal delivery are associated with increased risks in mothers and infants. Further research is needed to determine what aspects of obstetric care contribute to a delay in the provision of intrapartum interventions so that practices may be made safer when they are needed.

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Section: Discussionmentioning

confidence: 63%

“…If residual confounding cannot be excluded, it is unlikely that it might explain the magnitude of the excess risks we estimated for CS and operative vaginal delivery compared to spontaneous vaginal delivery. In addition, the odds ratios we calculated were of the same level as those reported in other recent studies [1]–[3].…”

Section: Discussionmentioning

confidence: 80%

Maternal and Perinatal Outcomes by Mode of Delivery in Senegal and Mali: A Cross-Sectional Epidemiological Survey

et al. 2012

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“…We recently conducted a study at a university hospital in Tanzania that revealed a sharp increase in CS rates between 2000 and 2011, and found the rise was accompanied by a significant increase in the maternal mortality ratio (MMR) [15]. Several studies have reported increased risk of blood transfusion [16, 17], hysterectomy [16, 17], bleeding complications [18], infections [18], and maternal death [13, 16, 17, 19] among women undergoing CS. However, assessing the risks of CS versus vaginal birth is complicated, as adverse outcomes after CS might be confounded by the medical condition that lead to the operation.…”

Section: Introductionmentioning

confidence: 99%

“…However, assessing the risks of CS versus vaginal birth is complicated, as adverse outcomes after CS might be confounded by the medical condition that lead to the operation. There are few publications with ideal study design to establish the causal relationship between CS and maternal morbidity and mortality [17, 19, 20]. …”

Section: Introductionmentioning

confidence: 99%

Maternal near-miss and death and their association with caesarean section complications: a cross-sectional study at a university hospital and a regional hospital in Tanzania

Litorp

Kidanto

Rööst

et al. 2014

BMC Pregnancy Childbirth

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BackgroundThe maternal near-miss (MNM) concept has been developed to assess life-threatening conditions during pregnancy, childhood, and puerperium. In recent years, caesarean section (CS) rates have increased rapidly in many low- and middle-income countries, a trend which might have serious effects on maternal health. Our aim was to describe the occurrence and panorama of maternal near-miss and death in two low-resource settings, and explore their association with CS complications.MethodsWe performed a cross-sectional study, including all women who fulfilled the WHO criteria for MNM or death between February and June 2012 at a university hospital and a regional hospital in Dar es Salaam, Tanzania. Cases were assessed individually to determine their association with CS. Main outcome measures included MNM ratio; maternal mortality ratio; proportion of MNM and death associated with CS complications; and the risk for such outcomes per 1,000 operations. The risk ratio of life-threatening CS complications at the university hospital compared to the regional hospital was calculated.ResultsWe identified 467 MNM events and 77 maternal deaths. The MNM ratio was 36 per 1,000 live births (95% CI 33–39) and the maternal mortality ratio was 587 per 100,000 live births (95% CI 460–730). Major causes were eclampsia and postpartum haemorrhage, but we also detected nine MNM events and five deaths from iatrogenic complications. CS complications accounted for 7.9% (95% CI 5.6–11) of the MNM events and 13% (95% CI 6.4–23) of the maternal deaths. The risk of experiencing a life-threatening CS complication was three times higher at the regional hospital (22/1,000 operations, 95% CI 12–37) compared to the university hospital (7.0/1,000 operations, 95% CI 3.8–12) (risk ratio 3.2, 95% CI 1.5–6.6).ConclusionsThe occurrence of MNM and death at the two hospitals was high, and many cases were associated with CS complications. The maternal risks of CS in low-resource settings must not be overlooked, and measures should be taken to avoid unnecessary CSs. More comprehensive training of staff, improved postoperative surveillance, and a more even distribution of resources within the health care system might reduce the risks of CS.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-244) contains supplementary material, which is available to authorized users.

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“…(Ash et al 2007;AWMF 2010c;Blanchette et al 2011;Chiu et al 2013;Ecker et al 2007; A c c e p t e d M a n u s c r i p t Getahun et al 2006;Greene et al 1996;Hemminki et al 1997;Kamilya et al 2010;Lee et al 2008;Liu et al 2007;Nawroth 2013;O`Neill et al 2013).…”

Section: Why Is (Emergency) Surgery That Used To Be Performed For Purmentioning

confidence: 95%

Is the narrow concept of individual autonomy compatible with or in conflict with Evidence-based Medicine in obstetric practice?

Maier

2014

Woman - Psychosomatic Gynaecology and Obstetrics

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Maternal mortality and cesarean delivery: An analytical observational study

Abstract: CD is increasingly perceived as a low-risk procedure. However, the present study clearly demonstrates that the risk of maternal death due to CD is significantly high, particularly when performed in labor. Therefore, CD should only be practiced when conditions clearly demand it.

Cited by 33 publications

References 14 publications

Maternal and Perinatal Outcomes by Mode of Delivery in Senegal and Mali: A Cross-Sectional Epidemiological Survey

Maternal and Perinatal Outcomes by Mode of Delivery in Senegal and Mali: A Cross-Sectional Epidemiological Survey

Maternal near-miss and death and their association with caesarean section complications: a cross-sectional study at a university hospital and a regional hospital in Tanzania

Is the narrow concept of individual autonomy compatible with or in conflict with Evidence-based Medicine in obstetric practice?

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