Outcomes and quality of care for women and their babies after caesarean section in Nigeria

Objective To describe the outcomes and quality of care for women and their babies after caesarean section (CS) in Nigerian referral‐level hospitals. Design Secondary analysis of a nationwide cross‐sectional study. Setting Fifty‐four referral‐level hospitals. Population All women giving birth in the...

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Published in:	BJOG : an international journal of obstetrics and gynaecology Vol. 131; no. S3; pp. 78 - 87
Main Authors:	Adeniran, Abiodun S., Nwachukwu, Duum C., Ocheke, Amaka N., Mohammed, Salisu O, Musa, Abdulkarim O., Ochejele, Silas, Ibraheem, Rais S., Pam, Samuel, Mairami, Amsa B., Gobir, Aishatu A., Olateju, Eyinade K., Baba, Fatimah J., Medupin, Patricia F., Ahmed, Grace, Ango, Sarah, Akaba, Godwin, Ogunkunle, Taofik O., Agada, Egwu, Gibbons, Luz, Oladapo, Olufemi T., Lavin, Tina, Tukur, Jamilu, Aboyeji, Abiodun P., Nurudeen, Azeezat T., Abdulateef, Zulikha O., Adepoju, Theresa R., Adekanye, Mariyetu O., Umar, Adamu A., Alhassan, Khalid Y., Zatchuk, Nenkimwa, Wambutda, Goler C., Ashuku, Terna I., Igbaba, Sarah M., Ogundiran, Lateef M., Anamah, Tony C., Owoyele, Adekunle G., Usman, Mustapha, Umar, Mohammed, Ajiboye, Titilope R., Okejie, Ojo J., Chinaedu, Bibiana
Format:	Journal Article
Language:	English
Published:	England Wiley Subscription Services, Inc 01-08-2024
Subjects:	Birth Births caesarean section Cesarean section Hospitals maternal complications maternal death Maternal mortality Mortality perinatal mortality Pregnancy complications Robson classification Sociodemographics Stillbirth Nigeria maternal death Robson classification perinatal mortality maternal complications caesarean section
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Summary:	Objective To describe the outcomes and quality of care for women and their babies after caesarean section (CS) in Nigerian referral‐level hospitals. Design Secondary analysis of a nationwide cross‐sectional study. Setting Fifty‐four referral‐level hospitals. Population All women giving birth in the participating facilities between 1 September 2019 and 31 August 2020. Methods Data for the women were extracted, including sociodemographic data, clinical information, mode of birth, and maternal and perinatal outcomes. A conceptual hierarchical framework was employed to explore the sociodemographic and clinical factors associated with maternal and perinatal death in women who had an emergency CS. Main Outcome Measures Overall CS rate, outcomes for women who had CS, and factors associated with maternal and perinatal mortality. Results The overall CS rate was 33.3% (22 838/68 640). The majority of CS deliveries were emergency cases (62.8%) and 8.1% of CS deliveries had complications after delivery, which were more common after an emergency CS. There were 179 (0.8%) maternal deaths in women who had a CS and 29.6% resulted from complications of hypertensive disorders of pregnancy. The overall maternal mortality rate in women who delivered by CS was 778 per 100 000 live births, whereas the perinatal mortality at birth was 51 per 1000 live births. Factors associated with maternal mortality in women who had an emergency CS were being <20 or >35 years of age, having a lower level of education and being referred from another facility or informal setting. Conclusions One‐third of births were delivered via CS (mostly emergency), with almost one in ten women experiencing a complication after a CS. To improve outcomes, hospitals should invest in care and remove obstacles to accessible quality CS services.
Bibliography:	For a list of collaborators with the Maternal and Perinatal Database for Quality, Equity and Dignity, see Appendix. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1470-0328 1471-0528 1471-0528
DOI:	10.1111/1471-0528.17815