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Perinatal outcomes of cesarean deliveries in Sierra Leone: A prospective multicenter observational study
Author(s) -
Duinen Alex J.,
Westendorp Josien,
Kamara Michael M.,
Forna Fatu,
Hagander Lars,
Rijken Marcus J.,
Leather Andrew J.M.,
Wibe Arne,
Bolkan Håkon A.
Publication year - 2020
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.13172
Subject(s) - medicine , obstetrics , sierra leone , antepartum hemorrhage , observational study , odds ratio , confidence interval , prospective cohort study , pregnancy , fetus , surgery , pathology , biology , development economics , economics , genetics
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.