Perinatal morbidity and mortality among babies delivered by caesarean section at Pumwani Maternity Hospital
Abstract
Background: The rate of caesarian sections globally has increased significantly in the past 20
years. Significant poor perinatal outcome has been documented in increased rates and World
Health Organization has recommended a rate of not more than 15% to minimize morbidity and
mortality. Recent studies from private hospitals in Nairobi have shown a higher CS rate attended
by better fetal outcome. Pumwani Maternity Hospital in a low cost setting handles about 60% of
all deliveries in Nairobi province. Operative deliveries are suspected to be high while the
outcome of babies delivered by in CS has not been described in recent years.
Objective: To determine the perinatal morbidity and mortality in caesarean section births at
Pumwani Maternity Hospital.
Design: Prospective descriptive study
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Study population: A prospective cohort of 286 neonates born by caesarean section.
Main outcome measure: Stillbirths, early neonatal deaths and neonatal illness (neonatal sepsis,
NEC, jaundice etc) on the seventh day.
Results: The CS rate was 17% with 251(87.8%) of operations being emergency sections.
Obstructed labour and fetal distress were the main indications for emergency CS at 30% and
27% respectively while PMCTC was the main indication for elective CS accounting for 54%.
There were 40 (14%) early neonatal deaths of which 28(70%) occurred within the first 24 hours.
Twenty one (53%) of the deaths were, babies of first time mothers. Asphyxia related early
neonatal deaths were 24(60%) while RDS related deaths accounted for 37.5%. Among the
39(13.6%) stillbirths in this study, 12(31 %) were MSB. The ENMR and perinatal mortality rates
were 161.911000 live births and 276 per 1000 total births respectively. Indications necessitating
emergency operations, intra operative maternal complications, and LBW had a significant risk
for morbidity and mortality (p< 0.05).