Tropical Journal of Obstetrics and Gynaecology

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Birth Asphyxia, Perinatal and Maternal Mortality Associated With Caesarean Section

Fidelis O. Njokanma, Matthias T.C. Egri-Okwaji, Chikezie A. Nwokoro, Taiwo Orebamjo, Godwin C.E. Okeke


Context: Caesarean section is sometimes required to improve maternal and neonatal outcome but adverse results occasionally occur. A review of associated adverse consequences is useful in identifying areas requiring improvement.

Objective: To study the association between caesarean delivery and maternal/fetal outcome.

Study Design, Setting and Subjects: A descriptive, fifteen-year report (1983 through 1997) from a private hospital in Lagos, Nigeria. The subjects were mothers delivered by caesarean section and their singleton babies.

Main Outcome Measures: Perinatal asphyxia rate, stillbirth rate, early neonatal death rate, maternal mortality rate.

Results: There were 1140 total deliveries. There were 240 cases (21.2%) of birth asphyxia and 16 early neonatal deaths (14.4/1000) among the 1113 live deliveries. There were 27 stillbirths (33.68/1000) and 3 maternal deaths (2.63/1000), all from emergency caesarean deliveries. Preterm delivery was associated with higher asphyxia rate (37.3% vs 22.8%, p < 0.05), while elective section had a lower asphyxia rate than emergency surgery (10.8% vs 24.3%, p < 0.05). Non-booked cases had significantly higher asphyxia rate (22.8% vs 3.9%), five-fold early stillbirth rate (95.54/1000 vs 18.24/1000), four-fold early neonatal death rate (42.25/1000 vs 10.40/1000) and a 12-fold higher maternal mortality rate (12.74/1000 vs 1.02/1000). Antepartum haemorrhage and hypertensive disease were the indications for surgery most frequently associated with perinatal mortality.

Conclusions: The hazards of caesarean section are worse with emergency surgery but significant asphyxia occurs even following elective section. Early appropriate referral of high-risk cases will help to reduce perinatal/maternal morbidity and mortality.

Key Words: Caesarean Section, Maternal, Neonatal, Mortality, Birth Asphyxia

[Trop J Obstet Gynaecol 2002; 19: 25-29].
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