An Analysis of the Rate, Indications, and Associated Maternal Mortality for Cesarean Sections at a Tertiary Care Hospital, First Report from Somalia

Figures & data

Table 1 Demographic Characteristics and C-Section Indications of the Study Population

Variables		Frequency	Percent
Age Group	<20 years	1225	9.8
	20–30	6441	51.3
	31–40	4576	36.5
	>40	298	2.4
Parity	Primapara	4051	32.3
	Multipara	8489	67.7
Gestational weeks	Preterm	2687	21.4
	Term	9853	78.6
Antenatal visits	Booked	3875	30.9
	Un booked	8665	69.1
Mode of delivery	Normal delivery	9837	78.4
	C-section	2703	21.6
Type of C-section	Elective	1104	40.8
	Emergency	1599	59.2
C-section indications	Previous C-section	604	22.3
	Fetal distress	598	22.1
	Preeclampsia	235	8.70
	Malpresentation	185	6.84
	CPD	157	5.81
	Prolonged labor	156	5.77
	Eclampsia	144	5.33
	Macrosomia	119	4.40
	Multiple gestation	114	4.22
	Placenta abruption	106	3.92
	Uterine rupture	104	3.85
	Placenta previa	88	3.26
	Cord prolapse	11	0.41
	Others*	82	3.03

Notes: *Others, Pregnant mothers with previous uterine surgeries (ie, myomectomy), mothers with severe traditional cervical cauterization, those with severe cardiac diseases, fetuses with congenital anomalies such as severe hydrocephaly, and mothers with bad obstetric history are included in other indications.

Figure 1 Yearly analysis of cesarean section trend.

Table 2 Determinants of Cesarean Section

Variables	Cesarean Delivery % n=2703	Odd Ratio		95% Cl
Maternal age (in years)
≤30	77.6%	4.31		3.74–4.98
>30	22.4%
Parity
Primapara	55.7%	3.59		3.34–3.93
Multipara	44.3%
Gestational weeks
Preterm (<37)	7.4%	0.24		0.20–0.28
Term(≥37 weeks)	92.6%
Antenatal visits
Booked	39.6%	2.15		1.94–2.39
Unbooked	60.4%
Type of Cesarean section
Elective	40.8%	1.76		1.73–1.78
Emergency	59.2%

Abbreviation: Cl, Confidence interval.

Table 3 Maternal Mortality Rate

Underlying Causes of Maternal Mortality	Total n= 216	Percentage%
Direct:
Hemorrhage
● PPH	83	(38.4%)
● Placenta abruption	24	(11.1%)
● Uterine rupture	18	(8.3%)
● Placenta Previa	7	(3.2)
Hypertension in pregnancy
● Eclampsia	28	(13%)
● Hellp syndrome	17	(7.9%)
Maternal sepsis	19	(8.8%)
Indirect:
● Anemia	9	(4.2%)
● Postpartum
Cardiomyopathy	11	(5.1%)
Total	216	100%