Incidence and determinants of neonatal morbidity after elective caesarean section at the national referral hospital in Kampala, Uganda

Annettee Nakimuli, Sarah Nakubulwa, Othman Kakaire, Michael O. Osinde, Scovia N. Mbalinda, Rose C. Nabirye, Nelson Kakande, Dan K. Kaye

Elective caesarean sections (ECS) have been implicated in increased risk of adverse neonatal outcomes. The primary objective was to assess the incidence and determinants of neonatal morbidity after elective caesarean section deliveries. The secondary objective was to describe the maternal morbidity associated with elective caesarean section. This was a prospective cohort study of women admitted for ECS, as well as their newborns, conducted at Mulago hospital from March 1, 2013 to February 28, 2014. These were followed from the time of the operation until 6 weeks after hospitalization following the caesarean delivery. Data was collected using an interviewer-administered questionnaire and review of medical records for demographic characteristics, obstetric history, current pregnancy complications and pregnancy outcomes up to hospital discharge. Study outcomes were maternal and neonatal morbidity. The data was analyzed using Stata version 12. There were 25,846 deliveries during the study period, of which 20,083 (77.7 %) were vaginal deliveries or assisted deliveries, and 5763 (22.3 %) were caesarean sections. Of the caesarean sections, 920 (15.9 %) were ECS. The commonest maternal morbidity was hemorrhage (17.2 %). A birth weight less than 2500 g (aRR 11.0 [95 % CI 8.1-17.2]) or more than 4000 g (aRR 12.2 [95 % CI 10.6-23.2]), delivery at gestation age less than or equal to 38 weeks (aRR 1.62 [95 % 1.20-2.10]), multigravidity (aRR 1.70 [95 % CI 1.20-2.90]) and using general anaesthesia (aRR 2.43 [95 % CI 1.20-5.90]) were associated with risk of neonatal morbidity. The commonest neonatal morbidity is respiratory distress especially if delivery occurs at a gestation age of 37 weeks or lower, if the birth weight is less than 2500 g or more than 4000 g, and if general anesthesia is used. Our study shows that at Mulago Hospital, ECS is associated with significant neonatal and maternal morbidity. We recommend that elective caesarean sections be performed after 39 weeks of gestation, and preferably avoid using general anaesthesia.