Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study
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Date
2019-04
Authors
Bishop, D.
Dyer, R.A.
Maswime, S.
Rodseth, R.N.
van Dyk, D.
Kluyts, H.
Omigbodun, A.O.
Ojewola, R.W.
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Abstract
Background 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.
Description
Staff publications
Keywords
Maternal , Neonatal , Surgical , Mortality , Research Subject Categories::MEDICINE::Surgery
Citation
Bishop D., Dyer R.A., Maswime S., Rodseth R.N., van Dyk D., Klutz H. et al. Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study. Lancet. Lancet Glob Health. 2019; 7: e513–22