Maternal mortality following caesarean section in a low-resource setting: a National Malawian Surveillance Study
Background Caesarean section (CS) is the most common major surgery conducted globally, with rates rising. CS also contributes to maternal morbidity and mortality, with increased risks in low-resource settings. We conducted a detailed review of maternal deaths from 2020 to 2022 in Malawi to determine...
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BMJ Publishing Group
2024-11-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/9/11/e016999.full |
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| author | Shakila Thangaratinam Louise Afran Maria Lisa Odland Luis Gadama David Lissauer Fannie Kachale Chifundo Ndamala Abi Merriel Catriona Waitt Amie Wilson Hussein H Twabi Annie Kuyere Jennifer Riches Yamikani Chimwaza Bertha Immaculate Magreta Chakhame Jack Milln Rosemary Bilesi Lumbani Makhaza Regina Makuluni Laura Munthali Owen Musopole Deborah A Phiri James Jafali |
| author_facet | Shakila Thangaratinam Louise Afran Maria Lisa Odland Luis Gadama David Lissauer Fannie Kachale Chifundo Ndamala Abi Merriel Catriona Waitt Amie Wilson Hussein H Twabi Annie Kuyere Jennifer Riches Yamikani Chimwaza Bertha Immaculate Magreta Chakhame Jack Milln Rosemary Bilesi Lumbani Makhaza Regina Makuluni Laura Munthali Owen Musopole Deborah A Phiri James Jafali |
| author_sort | Shakila Thangaratinam |
| collection | DOAJ |
| description | Background Caesarean section (CS) is the most common major surgery conducted globally, with rates rising. CS also contributes to maternal morbidity and mortality, with increased risks in low-resource settings. We conducted a detailed review of maternal deaths from 2020 to 2022 in Malawi to determine the burden of deaths related to CS, avoidable health system factors, and causes of death associated with this procedure.Methods Data were collected regarding every maternal death occurring across all district and central hospitals in Malawi, alongside facility-level aggregated birth data. Maternal deaths were reviewed by facility-based multidisciplinary teams with subsequent confirmation of cause of death by obstetricians according to international criteria. Logistic regression was applied to estimate the odds of associations of leading causes of death with CS while adjusting for potential confounders.Results Despite a low national CS rate, most deaths occurred following CS (51.8%, 276/533). Women who delivered by CS were five times (OR 5.60, 95% CI 4.74 to 6.67) more likely to die than women who delivered vaginally. The leading causes of death following CS were postpartum haemorrhage (26.0%, 68/277), eclampsia (15.6%, 41/277) and infection (14.1%, 37/277). Deaths from pregnancy-related infection were more often associated with CS (OR 2.03, 95% CI 1.12 to 3.72). Health system factors more frequently associated with deaths following CS than vaginal birth included ‘prolonged abnormal observations without action’ (p=0.006), ‘delay in starting treatment’ (p=0.006) and ‘lack of blood transfusion’ (p=0.03).Conclusions We found a high burden of maternal death following CS in this low-resource setting. Until now, international attention and many clinical trials have been focused on improving the safety of vaginal birth. Our findings highlight the need to ensure the safe and appropriate use of this potentially life-saving intervention to reduce maternal deaths. To avoid the high burden of death following CS we highlight, there is urgent need to develop and trial CS-specific interventions. |
| format | Article |
| id | doaj-art-341ed15464a9437ea33656e07a171aa0 |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Global Health |
| spelling | doaj-art-341ed15464a9437ea33656e07a171aa02024-12-06T06:05:08ZengBMJ Publishing GroupBMJ Global Health2059-79082024-11-0191110.1136/bmjgh-2024-016999Maternal mortality following caesarean section in a low-resource setting: a National Malawian Surveillance StudyShakila Thangaratinam0Louise Afran1Maria Lisa Odland2Luis Gadama3David Lissauer4Fannie Kachale5Chifundo Ndamala6Abi Merriel7Catriona Waitt8Amie Wilson9Hussein H Twabi10Annie Kuyere11Jennifer Riches12Yamikani Chimwaza13Bertha Immaculate Magreta Chakhame14Jack Milln15Rosemary Bilesi16Lumbani Makhaza17Regina Makuluni18Laura Munthali19Owen Musopole20Deborah A Phiri21James Jafali22Liverpool Women’s Hospital NHS Foundation Trust, Liverpool, UKDepartment of Women’s and Children’s Health, University of Liverpool, Liverpool, UKDepartment of Women’s and Children’s Health, University of Liverpool, Liverpool, UKKamuzu University of Health Sciences, Blantyre, MalawiMalawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, MalawiReproductive Health Directorate, Government of Malawi Ministry of Health, Lilongwe, Central Region, MalawiMalawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, MalawiDepartment of Women’s and Children’s Health, University of Liverpool, Liverpool, UKDepartment of Pharmacology and Therapeutics, Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UKLiverpool School of Tropical Medicine, Liverpool, UKDepartment of Women’s and Children’s Health, University of Liverpool, Liverpool, UKMalawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, MalawiDepartment of Women’s and Children’s Health, University of Liverpool, Liverpool, UKDepartment of Women’s and Children’s Health, University of Liverpool, Liverpool, UKNeonatal Health, University of Malawi Kamuzu College of Nursing, Lilongwe, Central, MalawiDepartment of Women’s and Children’s Health, University of Liverpool, Liverpool, UKReproductive Health Directorate, Government of Malawi Ministry of Health, Lilongwe, Central Region, MalawiMalawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, MalawiMalawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, MalawiMalawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, MalawiReproductive Health Directorate, Government of Malawi Ministry of Health, Lilongwe, Central Region, MalawiMalawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, MalawiDepartment of Women’s and Children’s Health, University of Liverpool, Liverpool, UKBackground Caesarean section (CS) is the most common major surgery conducted globally, with rates rising. CS also contributes to maternal morbidity and mortality, with increased risks in low-resource settings. We conducted a detailed review of maternal deaths from 2020 to 2022 in Malawi to determine the burden of deaths related to CS, avoidable health system factors, and causes of death associated with this procedure.Methods Data were collected regarding every maternal death occurring across all district and central hospitals in Malawi, alongside facility-level aggregated birth data. Maternal deaths were reviewed by facility-based multidisciplinary teams with subsequent confirmation of cause of death by obstetricians according to international criteria. Logistic regression was applied to estimate the odds of associations of leading causes of death with CS while adjusting for potential confounders.Results Despite a low national CS rate, most deaths occurred following CS (51.8%, 276/533). Women who delivered by CS were five times (OR 5.60, 95% CI 4.74 to 6.67) more likely to die than women who delivered vaginally. The leading causes of death following CS were postpartum haemorrhage (26.0%, 68/277), eclampsia (15.6%, 41/277) and infection (14.1%, 37/277). Deaths from pregnancy-related infection were more often associated with CS (OR 2.03, 95% CI 1.12 to 3.72). Health system factors more frequently associated with deaths following CS than vaginal birth included ‘prolonged abnormal observations without action’ (p=0.006), ‘delay in starting treatment’ (p=0.006) and ‘lack of blood transfusion’ (p=0.03).Conclusions We found a high burden of maternal death following CS in this low-resource setting. Until now, international attention and many clinical trials have been focused on improving the safety of vaginal birth. Our findings highlight the need to ensure the safe and appropriate use of this potentially life-saving intervention to reduce maternal deaths. To avoid the high burden of death following CS we highlight, there is urgent need to develop and trial CS-specific interventions.https://gh.bmj.com/content/9/11/e016999.full |
| spellingShingle | Shakila Thangaratinam Louise Afran Maria Lisa Odland Luis Gadama David Lissauer Fannie Kachale Chifundo Ndamala Abi Merriel Catriona Waitt Amie Wilson Hussein H Twabi Annie Kuyere Jennifer Riches Yamikani Chimwaza Bertha Immaculate Magreta Chakhame Jack Milln Rosemary Bilesi Lumbani Makhaza Regina Makuluni Laura Munthali Owen Musopole Deborah A Phiri James Jafali Maternal mortality following caesarean section in a low-resource setting: a National Malawian Surveillance Study BMJ Global Health |
| title | Maternal mortality following caesarean section in a low-resource setting: a National Malawian Surveillance Study |
| title_full | Maternal mortality following caesarean section in a low-resource setting: a National Malawian Surveillance Study |
| title_fullStr | Maternal mortality following caesarean section in a low-resource setting: a National Malawian Surveillance Study |
| title_full_unstemmed | Maternal mortality following caesarean section in a low-resource setting: a National Malawian Surveillance Study |
| title_short | Maternal mortality following caesarean section in a low-resource setting: a National Malawian Surveillance Study |
| title_sort | maternal mortality following caesarean section in a low resource setting a national malawian surveillance study |
| url | https://gh.bmj.com/content/9/11/e016999.full |
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