Prevalence and factors associated with severe anaemia post-caesarean section at a tertiary Hospital in Southwestern Uganda

Abstract

Background Severe anaemia after caesarean section adversely affects the woman and the new-born. While prenatal anaemia is extensively studied, the literature on post-caesarean section anaemia is limited and characteristics of women at the highest risk of developing severe anaemia after caesarean section are unknown. This study aimed to determine the prevalence and factors associated with severe anaemia on day three post caesarean section. Methods On the third day after caesarean section, women were consecutively enrolled in a cross-sectional study at Mbarara Regional Referral Hospital (MRRH). Women who got transfused peripartum were excluded. For every woman, we measured haemoglobin (Hb) concentration and collected data on sociodemographic, obstetric, and medical characteristics. The primary outcome was severe anaemia after caesarean section, defined as Hb < 7 g/dl. We used logistic regression analysis to determine factors associated with severe anaemia after caesarean section. P-value < 0.05 was considered statistically significant. Results From December 2019 to March 2020, 427 of 431 screened women were enrolled in the study. Their mean age was 26.05 (SD ± 5.84) years. Three hundred thirteen (73.3%) had attended at least four antenatal care visits. The prevalence of severe anaemia post-caesarean section was 6.79%. Foetus with macrosomia (aOR 7.9 95%CI: 2.18–28.85, p < 0.01) and having mild or moderate anaemia pre-caesarean section (aOR:9.6, 95%CI: 3.91–23.77, p < 0.01) were the factors associated with severe anaemia after caesarean section. Conclusion Severe anaemia in women post-caesarean section is relatively uncommon at our institution. It is associated with preoperative anaemia and macrosomic birth. Women with a low preoperative Hb concentration and those whose foetus have macrosomia could be targeted for haemoglobin optimisation before and during caesarean section.

Prevalence and Associated Factors for Post-Caesarean Delivery Blood Transfusion in Eastern Sudan: A Cross-Sectional Study

“… 28 However, other studies did not show this association. 8 , 29 Emergency CD carries the risk of intraoperative complications and haemorrhage with an increased need for blood transfusion.…”

“…Preoperative anaemia as a risk factor for transfusion has been reported in many studies. 5 , 12 , 29 , 30 Women who had preoperative anaemia were less tolerant of any amount of blood loss during surgery. A recent meta-analysis showed that the pooled prevalence of anaemia among pregnant women in Sudan was 53%.…”

Effectiveness Of Nutrition Booklet To Improve Participation In The Management Of Anemia In Cesarean Mothers

“…Cesarean surgery is an operation incurring a moderate risk of bleeding, and rates are rising globally (Ferguson & Dennis, 2018). Women with a low preoperative Hb concentration and fetuses with macrosomia may be targeted for screening and hemoglobin optimization before and during cesarean surgery (Sivahikyako et al, 2021). There are no practical guidelines for the identification and therapy of anemia and iron deficiency in the postoperative phase, although there are various guidelines for the management of anemia in surgical patients.…”

Prevalence of Post-Operative Anaemia and its Complications among Obstetric and Gynaecological Patients in Enugu

“…In a study of all surgical patients at Rivers State University Teaching Hospital Port-Harcourt, the prevalence of post-operative anaemia was found to be 70% [7]. In Uganda, a study of post-caesarean section patients gave a post-operative severe anaemia prevalence of 6.79% [8]. In a secondary analysis of a prospective observational CESARO-study using 800 adult patients undergoing elective surgeries from various operative disciplines across seven hospitals ranging from university hospitals, district general hospitals to specialist clinics of minimally access surgery in Germany, the prevalence of post-operative anaemia was 49.2% [9].…”

“…Some modifiable risk factors associated with anaemia include ignorance, illiteracy and poverty, and these factors are more in the developing countries of the world [4,10]. Post-operative anaemia is associated with various complications which may include wound sepsis, poor wound healing, pneumonia, venous thrombosis, stroke, delirium, acute myocardiac infarction and cardiac failure [8,[11][12][13][14][15]. All these can lead to increased cost of treatment and length of hospital stay Materials & Methods: This was a prospective, cohort study of women who had surgery at the ESUTH either for obstetric or gynaecological indications.…”