Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Tatale District Hospital, Tatale, Ghana.
PLoS One. 2023 Oct 31;18(10):e0293029. doi: 10.1371/journal.pone.0293029. eCollection 2023.
Regular evaluation of caesarean section (CS) is required due to their rising trend and outcomes. Many women recently opt for elective CS, even in resource-constrained settings. Data evaluating the outcomes of CS is however sparse. Hence, this study sought to determine the rate of fetal mortalities and their determinants following CS in the Tatale District Hospital of the Northern Region, Ghana.
A retrospective cross-sectional study was employed to analyze the medical records of 275 women who underwent CS from 2019 to 2021. Data were collected from the hospital's record of CS cases from 2019 to 2021. Descriptive statistics were used to summarize the data and Pearson's chi-square/Fisher's exact test was used to examine the relationship between maternal and obstetric characteristics and fetal mortality. At a 95% confidence interval (95% CI), logistic regression was fitted to assess significant variables and reported the results using odds ratio.
Of 1667 deliveries, 16.5% of the mothers gave birth by CS. A fetal mortality rate of 76.4 per 1000 total births was recorded following CS. Babies born with low Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores (0-3) at fifth-minute had an increased risk of fetal mortality (AOR = 523.19, 95%CI: 49.24-5559.37, p = <0.001). Having a history of previous CS, cephalopelvic disproportion and delayed labour were the major indications for CS.
Overall, this study found a high rate of CS based on the World Health Organization's recommended CS rate. Interventions such as reducing the waiting time for surgery and early diagnosis of the need for CS, and ensuring the availability of modern equipment to resuscitate infants with low APGAR scores can significantly improve fetal outcomes following CS.
由于剖宫产率不断上升及其结局，需要定期对剖宫产进行评估。最近，许多女性即使在资源有限的环境中也选择择期剖宫产。然而，评估剖宫产结局的数据却很少。因此，本研究旨在确定加纳北部地区塔塔莱地区医院剖宫产术后胎儿死亡率及其决定因素。
采用回顾性横断面研究，分析 2019 年至 2021 年期间 275 名接受剖宫产的妇女的病历。数据来自 2019 年至 2021 年医院剖宫产病例记录。采用描述性统计方法对数据进行总结，采用 Pearson 卡方检验/Fisher 确切检验分析产妇和产科特征与胎儿死亡之间的关系。采用 95%置信区间（95%CI），拟合逻辑回归评估显著变量，并使用优势比报告结果。
在 1667 例分娩中，16.5%的母亲通过剖宫产分娩。剖宫产术后总分娩胎儿死亡率为 76.4/1000。第五分钟时 Apgar 评分（0-3）较低的婴儿（新生儿阿普加评分）发生胎儿死亡的风险增加（OR=523.19，95%CI：49.24-5559.37，p<0.001）。有既往剖宫产史、头盆不称和产程延长是剖宫产的主要指征。
总体而言，本研究发现剖宫产率高于世界卫生组织推荐的剖宫产率。通过减少手术等待时间和早期诊断需要剖宫产的情况，以及确保有现代化设备来复苏 Apgar 评分较低的婴儿，可以显著改善剖宫产术后胎儿结局。
