Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study

a 7-day prospective observational cohort study

ASOS investigators

Research output: Contribution to journalArticle

9 Citations (Scopus)

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.


Original languageEnglish
Pages (from-to)e513-e522
Number of pages10
JournalLancet Global Health
Volume7
Issue number4
Early online date14 Mar 2019
DOIs
Publication statusPublished - Apr 2019

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Maternal Mortality
Observational Studies
Cohort Studies
Mothers
Outcome Assessment (Health Care)
Hemorrhage
Infant Mortality
Peripartum Period
Anesthesia
Placenta Previa
Abruptio Placentae
Hospital Mortality
Patient Selection
Obstetrics
Uterus
Odds Ratio
Research Personnel
Databases
Prospective Studies
Health

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study : a 7-day prospective observational cohort study. / ASOS investigators.

In: Lancet Global Health, Vol. 7, No. 4, 04.2019, p. e513-e522.

Research output: Contribution to journalArticle

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title = "Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study",
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.",
author = "David Bishop and Dyer, {Robert A} and Salome Maswime and Rodseth, {Reitze N} and {van Dyk}, Dominique and Hyla-Louise Kluyts and Tumukunde, {Janat T} and Madzimbamuto, {Farai D} and Elkhogia, {Abdulaziz M} and Ndonga, {Andrew K N} and Ngumi, {Zipporah W W} and Omigbodun, {Akinyinka O} and Amanor-Boadu, {Simbo D} and Eugene Zoumenou and Apollo Basenero and Munlemvo, {Dolly M} and Coulibaly Youssouf and Gabriel Ndayisaba and Akwasi Antwi-Kusi and Veekash Gobin and Patrice Forget and Bernard Mbwele and Henry Ndasi and Rakotoarison, {Sylvia R} and Samateh, {Ahmadou L} and Ryad Mehyaoui and Ushmaben Patel-Mujajati and Sani, {Chaibou M} and Esterhuizen, {Tonya M} and Madiba, {Thandinkosi E} and Pearse, {Rupert M} and Biccard, {Bruce M} and {ASOS investigators}",
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TY - JOUR

T1 - Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study

T2 - a 7-day prospective observational cohort study

AU - Bishop, David

AU - Dyer, Robert A

AU - Maswime, Salome

AU - Rodseth, Reitze N

AU - van Dyk, Dominique

AU - Kluyts, Hyla-Louise

AU - Tumukunde, Janat T

AU - Madzimbamuto, Farai D

AU - Elkhogia, Abdulaziz M

AU - Ndonga, Andrew K N

AU - Ngumi, Zipporah W W

AU - Omigbodun, Akinyinka O

AU - Amanor-Boadu, Simbo D

AU - Zoumenou, Eugene

AU - Basenero, Apollo

AU - Munlemvo, Dolly M

AU - Youssouf, Coulibaly

AU - Ndayisaba, Gabriel

AU - Antwi-Kusi, Akwasi

AU - Gobin, Veekash

AU - Forget, Patrice

AU - Mbwele, Bernard

AU - Ndasi, Henry

AU - Rakotoarison, Sylvia R

AU - Samateh, Ahmadou L

AU - Mehyaoui, Ryad

AU - Patel-Mujajati, Ushmaben

AU - Sani, Chaibou M

AU - Esterhuizen, Tonya M

AU - Madiba, Thandinkosi E

AU - Pearse, Rupert M

AU - Biccard, Bruce M

AU - ASOS investigators

N1 - FUNDING: Medical Research Council of South Africa.

PY - 2019/4

Y1 - 2019/4

N2 - 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.

AB - 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.

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U2 - 10.1016/S2214-109X(19)30036-1

DO - 10.1016/S2214-109X(19)30036-1

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SP - e513-e522

JO - Lancet Global Health

JF - Lancet Global Health

SN - 2214-109X

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