Maternal and fetal outcomes following delivery in a tertiary hospital in Johannesburg, South Africa

Abstract

Background. Caesarean section (CS) rates are rising worldwide. There is growing concern regarding the possible negative impacts on maternal and fetal health.

Objective. To assess birth outcomes of CS v. normal vaginal deliveries (NVD) using the Robson 10-group classification system at a tertiary hospital in Gauteng Province, South Africa. Primary postpartum haemorrhage (PPH), neonatal Apgar scores, neonatal intensive care unit admissions and perinatal deaths were recorded.

Methods. A retrospective review of all deliveries for neonates ≥500 g during September and October 2016 was undertaken. A total of 1 443 deliveries were assessed. The data were analysed using Statistical Package for the Social Sciences version 23.

Results. There were 730 (50.6%) CSs and 713 (49.4%) NVDs. The greatest contributor to the CS rate was group 5 (15.8%). PPH occurred in 8.3% of women delivered by CS, with an odds ratio (OR) of 1.86 (95% confidence interval (CI) 1.194 - 2.900). Additionally, three hysterectomies were performed in the CS group. A significant difference in Apgar scores was found only at 1 minute, with higher scores in the NVD group (CS mean (standard deviation) 7.74 (2.25), and NVD 8.10 (2.11); p=0.002). Eighty-nine (11.6%) neonates delivered by CS required high care admission, with an OR 1.865 (95% CI 1.292 - 2.692) for neonates delivered by CS.

Conclusion. The CS rate was 50.6%. Performing a CS should be weighed against the risks of the procedure. Although an understanding of some influences on the rate can be obtained, further research into indications, and protocol generation to optimise this rate, are needed to limit maternal and neonatal birth complications.