Abstract
Associations between anaesthetic techniques and pregnancy outcomes were assessed among 129,742 pregnancies delivered by caesarean section (CS) in low- and middle-income countries (LMICs) using two WHO databases. Anaesthesia was categorized as general anaesthesia (GA) and neuraxial anaesthesia (NA). Outcomes included maternal death (MD), maternal near miss (MNM), severe maternal outcome (SMO), intensive care unit (ICU) admission, early neonatal death (END), neonatal near miss (NNM), severe neonatal outcome (SNO), Apgar score <7 at 5 minutes, and neonatal ICU (NICU) admission. A two‐stage approach of individual participant data meta‐analysis was used to combine the results. Adjusted odds ratio (OR) with 95% confidence intervals (CIs) were presented. Compared to GA, NA were associated with decreased odds of MD (pooled OR 0.28; 95% CI 0.10, 0.78), MNM (pooled OR 0.25; 95% CI 0.21, 0.31), SMO (pooled OR 0.24; 95% CI 0.20,0.28), ICU admission (pooled OR 0.17; 95% CI 0.13, 0.22), NNM (pooled OR 0.63; 95% CI 0.55, 0.73), SNO (pooled OR 0.55; 95% CI 0.48, 0.63), Apgar score <7 at 5 minutes (pooled OR 0.35; 95% CI 0.29, 0.43), and NICU admission (pooled OR 0.53; 95% CI 0.45, 0.62). NA therefore was associated with decreased odds of adverse pregnancy outcomes in LMICs.
Highlights
Caesarean section (CS) can be a life-saving procedure for women and babies when potentially life-threatening complications occur during pregnancy or childbirth, such as abnormal fetal presentation, non-reassuring foetal condition, abnormal placentation, obstetric haemorrhage, and obstructed labor[1]
Spinal anaesthesia was the most common anaesthetic technique in both databases accounting for 48.9% in World Health Organization Global Survey (WHOGS) and 57.1% in World Health Organization Multi-Country Survey (WHOMCS)
Our findings of maternal mortalities attributable to general anaesthesia (GA) given during CS of 0.3% in WHOGS and 0.7% in WHOMCS were remarkably higher than that previously reported in a high-income country, where the rate was only 6.5 per million livebirths[9]
Summary
Caesarean section (CS) can be a life-saving procedure for women and babies when potentially life-threatening complications occur during pregnancy or childbirth, such as abnormal fetal presentation, non-reassuring foetal condition, abnormal placentation, obstetric haemorrhage, and obstructed labor[1]. A previous systematic review conducted to assess anaesthesia-attributed deaths of pregnant women in LMICs reported that anaesthesia accounted for 2.8% of all MD and 13.8% of MD after CS6. Most of the included studies were from sub-Saharan Africa and may not represent an overview of LMICs6. We performed this secondary analysis to assess the association between anaesthetic technique for CS and adverse pregnancy outcomes in LMICs using the two large WHO databases - The World Health Organization Global Survey (WHOGS) on Maternal and Perinatal Health[7] and The World Health Organization Multi-Country Survey (WHOMCS) on Maternal and Newborn Health[8]
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