Predictors of immediate neonatal outcome after cesarean section in Uganda

Objective Child mortality rates are high in sub-Saharan Africa and the proportion of early neonatal death is rising. Cesarean section is an effective way to prevent some neonatal deaths and also stillbirths. The present aim was to identify predictors of low Apgar score, immediate neonatal death, and stillbirth after cesarean section in Uganda. Methods Records of cesarean sections performed at all 14 regional referral hospitals and also 14 first-level (district) hospitals in Uganda were reviewed. Both elective and emergency cases were included. Data comprised mother's age, indication, type of anesthesia, and immediate outcome of the newborn. To evaluate the relation of the predictor variables to outcome, regression analysis was performed. Results 37 585 cesarean sections were recorded. The indications for cesarean section which led to the highest neonatal mortality and stillbirth rates and lowest mean Apgar score were uterine rupture and hemorrhage. Emergency surgery and general anesthesia had worse neonatal outcomes than elective surgery and spinal anesthesia. Compared to general anesthesia, spinal anesthesia was favorable for neonatal outcomes. Conclusion Elective surgical planning and scale-up of the use of spinal anesthesia may potentially reduce stillbirths and immediate neonatal deaths.