Perioperative outcomes and their associated factors among parturients undergoing caesarean delivery in Kawempe National Referral Hospital - A prospective observational

Abstract

Purpose: To determine the perioperative severe outcomes and their associated factors among parturients and their new-borns after caesarean delivery in Kawempe National Referral Hospital. Methods: The study was a prospective observational study. The sample size consisted of 404 parturients who underwent caesarean section from March to April of 2022 at KNRH, selected consecutively. Multivariate logistic regression analysis was performed to evaluate the association between severe maternal/foetal outcomes and different clinical factors. Results: 29.2% of the parturients had near-miss cases within 72 hours. Hypotension which requires vasopressor was the most common (37.76%) cause of near miss cases. A total of 13.86% of the neonates had an APGAR score of less than 7, and 3.93% had early neonatal death. Factors significantly associated with maternal near-miss were; massive bleeding (AOR=17.377, 95% CI: 3.887-77.693), postpartum haemorrhage (AOR=20.347, 95% CI: 6.034-68.603), and anesthesia complications (COR= 0.099, 95% CI: 0.064-0.151). Factors associated with severe foetal outcomes (low APGAR score, early neonatal death) were; ASA III classification (AOR 12= 2.256, 95% CI; 0.986-5.162), Anaesthesia complications (AOR = 0.448, 95% CI; 0.240-0.835), Years of experience (AOR = 3.785, 95% CI; 1.425-10.054), General Anaesthetic Technique (AOR = 0.116, 95% CI; 0.027-0.487) and Obstructed labour (AOR = 0.255, 95% CI; 0.124-0.525). Conclusion: We found high incidence of maternal near-miss. Massive bleeding, postpartum haemorrhage and anesthesia complications were found to be the major factors associated with severe maternal near miss during caesarean section at KNRH. We also noted a high prevalence of neonates having an APGAR score of less than 7 (13.86%) and early neonatal death (3.93%). An ASA-3 classification, anaesthetic complications, years of experience, general anaesthetic technique and obstructed labour, maternal unemployment, age above 35years and a gestational age of below 37 weeks were the major factors associated with low APGAR score and early neonatal death.