Maternal and perinatal outcomes in urgent referral and non-referral cases of emergency cesarean section at a district hospital in Zambia: a retrospective observational study

Abstract

We carried out a cross sectional survey using data from the patients who underwent emergency cesarean section and babies born by emergency cesarean section at Zimba Mission Hospital in 2017. Indications and maternal and perinatal outcomes were compared between urgent referral and non-referral cases. The sample comprised 266 cases of emergency cesarean section and 277 resulting neonates. Ninety-two (34.6%) cases were referred urgently from other facilities. Maternal, pregnancy, and delivery characteristics in the two groups were similar. Compared with the referral group, the non-referral group contained more cases of prolonged labor (47.8% vs. 62.1%; p = 0.036) and fewer cases of preeclampsia/eclampsia (7.6% vs. 1.7%; p = 0.035) and uterine rupture (4.3% vs. 0%; p = 0.025). Maternal outcomes in the two groups were similar. The perinatal mortality rate was higher in the referral than in the non-referral group (13.3% vs. 1.1%; p = 0.001). Referred cases had more severe indications and poorer perinatal outcomes of cesarean section, possibly due to the delays of cesarean section.

Keywords

• cesarean section
• urgent referral
• indications
• maternal outcomes
• perinatal outcomes
• zambia