Abstract
Objective: To identify the risk factors for early neonatal death (NND) despite cesarean section (CS). Methods: This case-control study was carried out between 1st February and 31st May, 2019. Files of women whose newborns died within seven days following CS and those of women whose newborns were alive seven days after CS were examined. The main variables recorded included maternal age, educational level, gestational age at delivery, number of antenatal visits done, whether the woman was referred or not, intrapartum fever or hemorrhage, indication of CS, decision delivery interval, birthweight and sex of newborn. Data were analyzed using SPSS 21.0. Fisher exact test, t-test and logistic regression were used for comparison. P<0.05 was considered statistically significant. Results: Our frequency of NND after CS was 4.8% (51/1053). Significant risk factors for NND after CS were birth weight <2000g (aOR 48.18, 95%CI 12.97-152.21), intra-partum hemorrhage (aOR 12.15, 95%CI 5.77-25.97), intra-partum fever (aOR 5.64, 95%CI 1.81-17.66), ˂4 antenatal visits (aOR 4.13, 95%CI 2.71-6.74), arrival ˃1h after referral (aOR 3.09, 95%CI 1.67-5.71) and primary school education level (aOR 2.39, 95%CI 1.16-4.92). Conclusion: From the risk factors identified above, we can recommend that women, especially those with primary school education level, should be counselled to attend at least four antenatal visits to allow the diagnosis and treatment of some diseases. Moreover, CS should be carried out as fast as possible in the cases of intrapartum hemorrhage. Women with intrapartum fever needs particular attention. Lastly, referral should be organized so that the woman arrives earlier.
Highlights
Cesarean section (CS) consists of performing a laparotomy and hysterotomy to deliver the fetus, though other techniques such as vaginal cesarean delivery does not need a prior laparotomy
The files of the three women whose newborns were delivered by CS immediately after the case and who were alive and healthy seven days after CS were recruited as controls
We had a total of 51 neonatal death (NND) out of 1053 CS performed, giving a rate of 4.8%
Summary
Cesarean section (CS) consists of performing a laparotomy and hysterotomy to deliver the fetus, though other techniques such as vaginal cesarean delivery does not need a prior laparotomy. High rate of 87.9% has been observed in Brazilian private health sectors [2] This surgical procedure carries some risks, especially the emergency CS. Short- and long-term complications include surgical site infection, thrombo-embolic diseases, urinary tract infection, uterine synechiae, morbidly adherent placenta and even uterine rupture during subsequent deliveries [3,4,5]. This procedure has a cost, especially in low- and middle-income countries where health insurance policies often do not exist and the family has to afford all the cost
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