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 .. 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).