[ad_1]
– Caesareans account for one in three operations on average in Africa and the neonatal mortality rate after caesarean section is twice the global average.
The maternal mortality rate after caesarean section in Africa could be 50 times higher than in high-income countries, according to an observational study of more than 3,500 mothers in 22 African countries published in The Lancet Global Health newspaper.
The study found that the maternal mortality rate appears to be significantly higher than expected at 5.43 per 1,000 operations (based on 20 deaths after caesarean section out of 3,684 African mothers studied), compared with 0.1 per 1,000 operations in the United Kingdom. [1]
One in six women had complications during surgery (17.4%, 633 women out of 3,366), almost three times more than American women (6.4%, 85,838 women out of 1,339,397 presented complication). [2]. Severe peroperative and postoperative bleeding was the most common complication among African women; they occurred in 3.8% of mothers (136 out of 3,612).
The results highlight the urgent need to improve the safety of the procedure. Mothers who had preoperative placental complications, uterine rupture, bleeding before birth, severe obstetric bleeding during surgery, and complications of anesthesia were more likely to die after cesarean section. .
Professor Bruce M. Biccard, of the University of Cape Town, South Africa, who led the study, said: "Improving the surgical results of caesarean section could dramatically improve mortality. maternal and newborn, which would result in key gains for global health.Our findings could potentially inform interventions aimed at improving the safety of caesarean sections for mother and baby, including early identification of risk (eg risk of bleeding), reducing the threshold for the use of drugs used to treat postpartum hemorrhage, especially where blood availability is low, improving access to blood and blood products having a long life, and innovative methods of training non-physician anesthesiologists, including online badistance and mobile applications. " [3]
Previous research on caesareans and maternal mortality in Africa has used small data sets and has not studied the badociated risk factors needed to inform interventions to improve the safety of caesareans. This study aimed to fill these gaps by recording maternal mortality and complications in 3,792 women with unscheduled caesarean deliveries.
This study is part of the ASOS (African Surgical Outcomes Study), a large cohort study measuring the surgical results of all patients operated for 7 days in 183 hospitals in 22 African countries. In the first study, caesareans were the most common surgery, accounting for one third of all surgical procedures (33%, 3,792 out of 11,422 patients). [4].
A series previously published in The Lancet also pointed out that caesarean rates remain too low in many low-income countries [5]. In the new study, three-quarters of registered births were clbadified in emergency surgery (78.2%, 2,867 females), mothers arriving at surgery with preoperative risk already high due to complications related to pregnancy, including pre-eclampsia. or eclampsia (12.2%, 450/3685 women), or significant preoperative bleeding risk (5.9%, 216/3685 women) due to placenta previa, placental abruption, uterine rupture, and of antepartum hemorrhage. The authors highlight the need to improve access to Caesarean delivery for women who need it, while making surgery safer. Faster access to surgery may help reduce risk.
"Paradoxically, as many countries seek to reduce the rate of cesarean deliveries, the increase in cesarean delivery rates remains a priority in Africa." In sub-Saharan Africa, the rate of births is still a priority. Caesarean delivery is static at 3.5%, despite a rising global rate Increase in access to surgery may allow patients to report earlier and avoid complications and deaths, but it is critical that this improvement occur alongside programs to improve patient safety during cesarean delivery, "said Professor Biccard. [3]
Importantly, the study also highlights the scarcity of specialized care available, which averaged 0.7 specialists per 100,000 population. On average, the hospitals surveyed had three specialist obstetricians, three specialist surgeons and two specialized anesthesiologists. Nearly one in four women was anesthetized by a non-specialist and, since 10% of recorded deaths occurred after complications of anesthesia, the authors point out the need for safer anesthesia for women during cesarean delivery.
The study also found that the neonatal mortality rate (deaths in the first 28 days of life) after cesarean section in Africa was double the global average. The global average for all deliveries in 2016 was 19 per 1,000, while the rate recorded in the study was 44 per 1,000 births (based on 153 deaths out of 3,506 live births). ).
Commenting on the generalizability of their findings across Africa, the authors noted that the study included less than half of African countries and that two-thirds of the population in Africa reported to the study. The study belonged to middle-income countries, while many of the continent's poorest countries were not included. The authors also note that their study includes a disproportionate number of public hospitals compared to district hospitals. Public hospitals tend to provide a higher level of care and have better resources than district hospitals, which are usually the primary caregivers for mothers during childbirth. These factors may mean that maternal mortality rates in the study are conservative.
Anna J Dare, University of Toronto, comments on the importance of improving the delivery of caesareans in Africa: "Despite the still low rates of cesarean section reported in sub-Saharan Africa, caesareans were still the most common surgical treatment. procedures performed in the largest ASOS cohort, accounting for one-third of all operating procedures … As a result, a strong argument can be made for coordinated efforts to improve and standardize the quality of care around the world. cesarean delivery, while seeking to improve access … Substantial progress has been made over the last 20 years in reducing maternal mortality, including in Africa, and yet overall disparities persist at all levels of obstetric care.
.
###
NOTES TO EDITORS
This study was funded by the Medical Research Council of South Africa. It was conducted by researchers from the University of KwaZulu-Natal, Groote Schuur Hospital, the University of the Witwatersrand, Sefako Makgatho University Health Sciences, the University of 39; Makerere University, Tripoli College of Health Sciences, Tripoli Medical Center, Mater Hospital, and the University of Nairobi. Medicine, University of Ibadan, University Hospital, Namibian Ministry of Health and Social Services, Kinshasha University Hospital, Bamako Medical School, Kamenge University Hospital, Kwame Nkrumah University of Science and Technology, Jawaharlal Nehru Hospital , Vrije Universiteit Brussel and Universitair Ziekenhuis Brussel, Christian Social Work Commission, Baptist Hospital, Edward Francis Small University Hospital, University Hospital, Lusaka University Hospital, Niamey National Hospital, Stellenbosch University, Queen Mary University, London.
Labels have been added to this press release as part of an Academy of Medical Sciences project to improve the communication of evidence. For more information, please visit: http: // www.
IF YOU WANT TO PROVIDE A LINK TO YOUR READERS, PLEASE USE THE FOLLOWING ELEMENTS THAT WILL LIVE AT THE TIME OF THE EMBARGO ELEMENTS: http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19) 30036 -1 / full text
Peer Review / Observational Study / People
Source link
