Riches, Jennifer 
ORCID: 0000-0003-4727-1767, Chimwaza, Yamikani ORCID: 0000-0003-1563-341X, Magreta Chakhame, Bertha Immaculate, Milln, Jack ORCID: 0000-0002-3464-6577, Twabi, Hussein H ORCID: 0000-0003-4473-296X, Bilesi, Rosemary, Gadama, Luis, Kachale, Fannie, Kuyere, Annie, Makhaza, Lumbani et al (show 13 more authors)
(2024)
Maternal mortality following caesarean section in a low-resource setting: a National Malawian Surveillance Study.
BMJ global health, 9 (11).
e016999-e016999.
ISSN 2059-7908, 2059-7908
Abstract
<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusions</h4>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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Humans, Postpartum Hemorrhage, Cesarean Section, Cause of Death, Maternal Mortality, Pregnancy, Adolescent, Adult, Malawi, Female, Young Adult |
| Divisions: | Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Life Courses & Medical Sciences Faculty of Health & Life Sciences > Inst. Systems, Molec & Integrative Biology > Inst. Systems, Molec & Integrative Biology |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 29 Nov 2024 16:41 |
| Last Modified: | 28 Feb 2026 01:06 |
| DOI: | 10.1136/bmjgh-2024-01699 |
| Open Access URL: | https://pmc.ncbi.nlm.nih.gov/articles/PMC11590827/ |
| Related Websites: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3188952 |
| Disclaimer: | The University of Liverpool is not responsible for content contained on other websites from links within repository metadata. Please contact us if you notice anything that appears incorrect or inappropriate. |
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