Outcome of caesarean section at the Edward Francis Small Teaching Hospital, Banjul The Gambia

Beyond proximity: an observational study of stillbirth rates and emergency obstetric and newborn care accessibility in The Gambia

INTRODUCTION

Stillbirths are disproportionately concentrated in sub-Saharan Africa, where geographical accessibility to basic/comprehensive emergency obstetric and newborn care (BEmONC and CEmONC) significantly influences maternal and perinatal outcomes. This study describes stillbirth rates within healthcare facilities in The Gambia and examines their distribution in relation to the geographical accessibility of these facilities.

METHODS

We analysed 97 276 births recorded between 1 January 2013 and 31 December 2018, from 10 major public healthcare facilities in The Gambia. To standardise definitions, stillbirths were defined as fetal deaths with a birth weight of ≥500 g. Fresh stillbirths were reclassified as intrapartum, and macerated stillbirths were reclassified as antepartum. Linear regression with cubic splines was used to model trends, and AccessMod software estimated travel times to facilities.

RESULTS

Among recorded births, 5.1% (4873) were stillbirths, with an overall stillbirth rate of 51.3 per 1000 births (95% CI: 27.5 to 93.6). Intrapartum stillbirths accounted for 53.8% (27.6 per 1000 births; 95% CI: 14.4 to 49.8). Fully functional CEmONC facilities reported the highest stillbirth rates, including the National Teaching Hospital (101.7 per 1000 births, 95% CI: 96.8 to 106.8). Approximately 42.8%, 58.9% and 68.3% of women aged 15-49 lived within a 10, 20 and 30 min travel time, respectively, to fully functional CEmONC facilities, where high stillbirth rates were concentrated.

CONCLUSIONS

In The Gambia, intrapartum stillbirth rates remain alarmingly high, even in geographically accessible CEmONC facilities. Inadequate documentation of fetal heart rate on admission hampers accurate classification, complicating targeted interventions. Ensuring that EmONC-designated facilities-particularly those providing BEmONC services-are fully functional with essential equipment, trained staff and robust referral systems, while enhancing the timeliness and quality of obstetric care, is crucial to reducing stillbirth rates.

Factors Associated with High Rates of Caesarean Deliveries: A Cross Sectional Study Classifying Deliveries According to Robson in Mengo Hospital Kampala

Introduction

The number of caesarean section (CS) continues to rise worldwide. CS can improve outcomes in infants and mothers. However, if used improperly, the potential harm can outweigh the potential benefits.

Aim

The study was to determine the factors associated with high cesarean section rates at Mengo Hospital.

Methods

This cross-sectional study used a mixed-method approach that included a retrospective review of 1276 casebooks using the Robson Ten Group Classification System (RTGCS) for births that occurred at Mengo Hospital in December 2018, January, and February 2019. Questionnaire was used for data collection from 200 mothers on second day after birth from 24th May to 19th July 2019. Eight key informants were interviewed within the same period. Quantitative data were analyzed using STATA V.14, thematic analysis for qualitative data. Univariate, bivariate, and multivariate analyses were performed to determine the association between predisposing factors and outcome variables using chi-square and modified Poisson.

Results

Caesarean section rate (CSR) from casebooks was 49% and 64% from the primary data. Group 5(Previous CS, single cephalic, >37 weeks) had (35.4%) to the total number of cesarean deliveries, followed by Group 1 (Nulliparous, single cesarean deliveries, >37 weeks in spontaneous labour), with 18.4%. Group 3 (ultiparous (excluding previous CS), single cephalic, >37 weeks of spontaneous labor) with (13.7%). The common indications from casebooks were a previous scar (32%), obstructed labor (18%), and previous scar (97.6%). Presence of an obstetric indication, influence of husband, friends, relatives, and mother's desire for a CS were closely associated with caesarean delivery. Mothers said that occurrence of CS was due to health workers reducing the stress of monitoring labour and financial benefits from CS deliveries by the hospital.

Conclusion

Repeat CS made the highest CSR contribution; therefore, strategies to reduce the frequency of the procedure should include avoiding medically unnecessary primary CS and encouraging vaginal birth after previous CS where applicable.

Differences in Cesarean section rates by fetal sex among Chinese women in the United States: Does Chinese culture play a role?

To investigate whether elements of Chinese culture, such as son preference, influence women's mode of child delivery, this paper analyzes how fetal sex affects C-section rates among Chinese mothers compared with Japanese mothers in the United States. It uses birth certificate data from 1990 to 2000, a period when women were routinely able to learn the sex of the fetus during pregnancy. Compared with Japanese mothers, Chinese mothers were 1 percentage point more likely to undergo C-section when giving birth to boys than when giving birth to girls. This result is robust to the addition of a rich set of controls and the restriction of the sample to infants without congenital diseases or anomalies at birth. The effects are concentrated in subgroups that are more likely to prefer sons-specifically, where both parents are Asian or where mothers are first-generation immigrants. The findings offer valuable insights for health professionals into culturally driven pregnancy behaviors among Chinese women, potentially enabling them to offer more culturally appropriate healthcare as they support women in making a healthy transition to motherhood.