Abstract
BackgroundEmerging evidence from a recent pilot universal newborn hearing screening (UNHS) programme suggests that the burden of obstetric complications associated with mode of delivery is not limited to maternal and perinatal mortality but may also include outcomes that undermine optimal early childhood development of the surviving newborns. However, the potential pathways for this association have not been reported particularly in the context of a resource-poor setting. This study therefore set out to establish the pattern of delivery and the associated neonatal outcomes under a UNHS programme.MethodsA cross-sectional study in which all consenting mothers who delivered in an inner-city tertiary maternity hospital in Lagos, Nigeria from May 2005 to December 2007 were enrolled during the UNHS programme. Socio-demographic, obstetric and neonatal factors independently associated with vaginal, elective and emergency caesarean deliveries were determined using multinomial logistic regression analyses.ResultsOf the 4615 mothers enrolled, 2584 (56.0%) deliveries were vaginal, 1590 (34.4%) emergency caesarean and 441 (9.6%) elective caesarean section. Maternal age, parity, social class and all obstetric factors including lack of antenatal care, maternal HIV and multiple gestations were associated with increased risk of emergency caesarean delivery compared with vaginal delivery. Only parity, lack of antenatal care and prolonged/obstructed labour were associated with increased risk of emergency compared with elective caesarean delivery. Infants delivered by vaginal method or by emergency caesarean section were more likely to be associated with the risk of sensorineural hearing loss but less likely to be associated with hyperbilirubinaemia compared with infants delivered by elective caesarean section. Emergency caesarean delivery was also associated with male gender, low five-minute Apgar scores and admission into special care baby unit compared with vaginal or elective caesarean delivery.ConclusionsThe vast majority of caesarean delivery in this population occur as emergencies and are associated with socio-demographic factors as well as several obstetric complications. Mode of delivery is also associated with the risk of sensorineural hearing loss and other adverse birth outcomes that lie on the causal pathways for potential developmental deficits.
Highlights
Emerging evidence from a recent pilot universal newborn hearing screening (UNHS) programme suggests that the burden of obstetric complications associated with mode of delivery is not limited to maternal and perinatal mortality but may include outcomes that undermine optimal early childhood development of the surviving newborns
Emergency caesarean section rate was highest among Yoruba tribe (69.6%), Christian mothers (65.1%), those living in rented accommodation (96%) and those in the middle social class (73.2%)
Infants delivered by vaginal method or emergency caesarean section were more likely to be associated with the risk of sensorineural hearing loss but less likely to be associated with hyperbilirubinaemia compared with infants delivered by elective caesarean section
Summary
Emerging evidence from a recent pilot universal newborn hearing screening (UNHS) programme suggests that the burden of obstetric complications associated with mode of delivery is not limited to maternal and perinatal mortality but may include outcomes that undermine optimal early childhood development of the surviving newborns. It is widely acknowledged that effective efforts aimed at improving child health in resource-poor countries must be preceded and underpinned by improvement in maternal health within a continuum of care from pregnancy to adolescence [1] This is corroborated by substantial evidence showing that regions such as sub-Saharan Africa and South Asia with the highest rates of maternal mortality have the highest burden of infant and child mortality worldwide [2,3,4,5]. In many developing countries undue delays in initiating life-saving surgical intervention for women at risk of severe complications among other factors may undermine the envisaged outcomes from facility-based services [3,8] Such delays may be due to delay in seeking essential obstetric care; in reaching the hospital or appropriate health facility; or in receiving adequate care in the hospital [8]. Barring the absence of other barriers such as cost and accessibility, refusal of life-saving caesarean section is not uncommon among women in urban settings in sub-Saharan Africa in a country like Nigeria which is a leading contributor to regional and global burden of maternal mortality [9,10,11,12,13]
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