Perioperative mortality of caesarean section in North-West Ethiopia: a prospective cohort study

Objective: This study aimed to assess 7-day perioperative maternal mortality and risk factors at Tibebe Ghion Specialized Hospital.

Design: A single-centre prospective cohort study.

Setting: A tertiary hospital in North-West Ethiopia, 01 June 2019 to 30 June 2021.

Participants: A total of 979 pregnant mothers who underwent caesarean section were enrolled in this study. Mothers who did not have cellphones and who had incorrect information for follow-up were excluded from the study.

Outcome measure: Perioperative death measured from intraoperative time to the seventh day following caesarean section.

Results: The most frequent indication for caesarean section was failure to progress, followed by fetal distress and elective caesarean delivery, accounting for 40.04%, 24.72% and 20.43% of all cases, respectively. The 7-day perioperative maternal mortality rate was 1.83%. Maternal bleeding (adjusted relative risk (ARR) = 11.80; 95% CI 1.12, 124.08) and not using the WHO surgical safety checklist (ARR = 6.88; 95% CI 3.14, 15.07) were independently associated with increased risk of 7-day perioperative mortality.

Conclusion: In this study, mortality after caesarean section was higher than in high-income countries. Implementation of targeted interventions focusing on the prevention and management of maternal bleeding, along with the consistent use of the WHO surgical safety checklist, could potentially contribute to improving the overall safety and outcomes of caesarean sections.