Comparative Study of Pregnancy Outcomes Among Women With High and Low Order Caesarean Deliveries at Kenyatta National Hospital Between January 2020 to December 2022

Abstract

Background: From the literature, there is consensus that CS deliveries increase the odds of adverse maternal and perinatal outcomes such as mortality, PPH incidence, and poor Apgar scores to name a few. It is also hypothesized that women who undergo high order caesarean sections (HOCS) seem to have a significantly higher odds of developing adverse maternal outcomes compared to those who have low order caesarean sections (LOCS) and comparable perinatal outcomes, even though data from low-income settings in Africa is limited. The data could inform management approaches of women who undergo HOCS to improve outcomes. Study design: Retrospective Cohort Study Study site: Kenyatta National Hospital (KNH) health records department Population: Women who had a high order caesarean delivery or low order caesarean delivery at KNH between January 2020 to December 2022 and meet the inclusion criteria for the study. Broad objective: Compare the pregnancy outcomes of women who had a high order caesarean delivery compared to a low order caesarean delivery at KNH Material and methods: Patient details will be retrieved from the health records department at Kenyatta National Hospital (KNH) and consecutive sampling will be used to recruit 162 women who underwent high order caesarean sections and 324 women who underwent low order caesarean sections over the study duration. The hospital files of selected patients will be retrieved and a data abstraction tool used to document data on demographic characteristics such as age, marital status, and education level, maternal outcomes such as mortality and length of hospital stay, neonatal factors such as birth weight and Apgar scores, perinatal highrisk events such as number of previous caesarean sections, gestation age at time of caesarean delivery, and type of CS, intraoperative events such as bladder injury uterine rupture and the need for blood transfusions, and postoperative events such paralytic ileus, wound infection, or chest infection. Data analysis will be conducted using version 25 of the Statistical Package for Social Scientist (SPSS) for Windows. The data will be extracted from abstraction tools, uploaded into an SPSS spreadsheet, checked for errors and outliers, and cleaned in readiness for analysis. The biodata of patients who had a high order caesarean section and low order caesarean section will be summarised using descriptive statistics and measures of central tendency and compared using the Chi-square test. Prenatal high-risk events, intraoperative events, postoperative events, the perinatal outcomes, and maternal outcomes of mothers who had a high order caesarean section and low order caesarean section will be compared using Chi square test (bivariate analysis) and Logistic regression (multivariable) at 95% confidence level. P-value <0.05 will be significant.