Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Lancet Glob Health. 2019 Apr;7(4):e513-e522. doi: 10.1016/S2214-109X(19)30036-1.
Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes.
A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899.
Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0).
Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa.
Medical Research Council of South Africa.
非洲的孕产妇和新生儿死亡率很高，但很少有大型的前瞻性研究来调查与这些不良孕产妇和新生儿结局相关的风险因素。
在非洲 22 个国家的 183 家医院进行了为期 7 天的国际前瞻性观察性队列研究。纳入标准为所有连续患者（年龄≥18 岁），在 7 天的研究队列期间，在参与中心接受择期和非择期剖宫产。为确保代表性样本，每家医院在招募周内必须为 90%的合格患者提供数据。主要结局是院内孕产妇死亡率和并发症，由当地研究人员评估。该研究在南非国家卫生研究数据库注册，编号为 KZ_2015RP7_22，并在 ClinicalTrials.gov 注册，编号为 NCT03044899。
2016 年 2 月至 2016 年 5 月，从非洲各地的医院共招募了 3792 名患者。3685 名患者纳入术后并发症分析（107 例数据缺失），3684 名患者纳入孕产妇死亡率分析（108 例数据缺失）。这些医院的专科外科医生、产科医生和麻醉师总数为每 10 万人 0.7 人（IQR 0.2-2.0）。3684 名患者中有 20 名（0.5%）死亡（95%CI 0.3-0.8）。3636 名母亲中有 633 名（17.4%）发生并发症（16.2-18.6%），主要为术中及术后严重出血（3612 名母亲中有 136 名[3.8%]）。孕产妇死亡率与术前胎盘前置、胎盘早剥、子宫破裂、产前出血（比值比 4.47[95%CI 1.46-13.65]）和围手术期严重产科出血（5.87[1.99-17.34]）或麻醉并发症（11.47[1.20-109.20]）独立相关。3506 名婴儿中有 153 名（4.4%）死亡（95%CI 3.7-5.0）。
非洲剖宫产术后的孕产妇死亡率是高收入国家的 50 倍，主要由围产期出血和麻醉并发症导致。新生儿死亡率是全球平均水平的两倍。早期识别和适当处理有围产期出血风险的产妇可能会改善非洲的孕产妇和新生儿结局。
南非医学研究理事会。
