Abstract
BackgroundCaesarean section rates have increased worldwide in recent decades. Caesarean section is an essential maternal healthcare service. However, it has both maternal and neonatal adverse outcomes. Therefore this systematic review and meta-analysis aimed to estimate the prevalence, indication, and outcomes of caesarean section in Ethiopia.MethodsTwenty three cross-sectional studies with a total population of 36,705 were included. Online databases (PubMed/Medline, Hinari, Web of Science, and Google Scholar) and online university repository was used. All the included papers were extracted and appraised using the standard extraction sheet format and Joanna Briggs Institute respectively. The pooled prevalence of the caesarean section, indications, and outcomes was calculated using the random-effect model.ResultThe overall pooled prevalence of Caesarean section was 29.55% (95% CI: 25.46–33.65). Caesarean section is associated with both maternal and neonatal complications. Cephalopelvic disproportion [18.13%(95%CI: 12.72–23.53] was the most common indication of Caesarean section followed by non-reassuring fetal heart rate pattern [19.57% (95%CI: 16.06–23.08]. The common neonatal complications following Caesarean section included low APGAR score, perinatal asphyxia, neonatal sepsis, meconium aspiration syndrome, early neonatal death, stillbirth, and prematurity whereas febrile morbidity, surgical site infection, maternal mortality, severe anemia, and postpartum hemorrhage were the most common maternal complications following Caesarean section.ConclusionIn this systematic review and meta-analysis, the rate of Cesarean section was high. Cephalopelvic disproportion, low Apgar score, and febrile morbidity were the most common indication of Caesarean section, neonatal outcome and maternal morbidity following Caesarean section respectively. Increasing unjustified Caesarean section deliveries as a way to increase different neonatal and maternal complications, then several interventions needed to target both the education of professionals and the public.
Highlights
Caesarean section rates have increased worldwide in recent decades
Characteristics of the included studies Four hundred twenty-three studies were retrieved at PubMed, Google Scholar, Science Direct, web of science, HINARI and other gray and online repository accessed articles regarding prevalence, indications, and the maternal and fetal outcome of Caesarean section in Ethiopia
102 full-text articles were accessed and assessed for inclusion criteria, which resulted in the further exclusion of 79 articles primarily due to reason
Summary
Caesarean section rates have increased worldwide in recent decades. Caesarean section is an essential maternal healthcare service. It has both maternal and neonatal adverse outcomes. Despite Caesarean section a life saving medical intervention and procedures to the decrease adverse birth outcome, controlling different postoperative neonatal and maternal complications are challenging in terms of patient safety, long duration of hospital stay, cost and psychological trauma. Maternal outcomes of Caesarean section included: postpartum fever, surgical site infection, puerperal sepsis, maternal mortality whereas neonatal sepsis, early neonatal death, stillbirth, perinatal asphyxia, low Apgar score, and prematurity were the most common complication of the newborn [4,5,6]
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