Method of Anesthesia and Perioperative Risk Factors, Maternal Anesthesia Complications, and Neonatal Mortality Following Cesarean Delivery in Africa: A Substudy of a 7-Day Prospective Observational Cohort Study

Abstract

(Anesth Analg. 2024;138(6):1275–1284.) Maternal and neonatal mortality rates are significantly high in Africa. The African Surgical Outcomes Study (ASOS) revealed that maternal mortality (MM) following cesarean delivery is 50 times higher in Africa compared with high-income countries, primarily due to obstetric hemorrhage and anesthesia complications. General anesthesia (GA) was particularly risky, with 1 in 66 GAs resulting in maternal death and a higher MM rate compared with spinal anesthesia (SA) (1.5% vs. 0.3%). A substudy was conducted within ASOS to estimate the association between preoperative risk factors and anesthesia methods. Secondary aims included examining the relationship between anesthesia type and maternal intraoperative hypotension, severe anesthesia complications, and neonatal mortality. This secondary analysis of the ASOS obstetric cohort involved patients aged 18 and older across 183 hospitals in 22 African countries. Data collected included gravidity, parity, gestational age, and complications like preeclampsia and eclampsia. The study followed the STROBE guidelines and received ethical approvals from relevant committees.