(826) Maternal and Neonatal Outcomes by Mode of Delivery in Botswana

Cesarean births (CB) are associated with morbidity globally; however, risks of CB have not been well-quantified in Botswana. This study aimed to investigate maternal and neonatal outcomes in a large cohort in Botswana by mode of delivery.

 

Study Design:

Maternal and neonatal outcomes were abstracted from medical records at discharge for births at Princess Marina Hospital, the largest tertiary referral hospital in Botswana. We evaluated maternal and neonatal outcomes, impact of CB indications, and interventions by mode of delivery.


Results:

From November 2021 to October 2024, 16,419 births were recorded; 11,753 (71.6%) vaginal births (VB) and 4,666 (28.4%) CB. Of those with known CB indication, 241 (6.0%) were categorized as planned without known risk factors, 2235 (55.9%) were planned with risk factors, 566 (14.2%) had a failed VB attempt/labor dystocia, and 954 (23.9%) were for urgent/emergent indications. Demographic factors were comparable overall, with notably increased (median ±SD) age (30.4±6.3 years versus 27.8±7.0 years), weight (81.1±18.6 kilograms versus 75.2±16.8 kilograms) and parity (1.4±1.2 births versus 1.2±1.4 births) in CB versus VB groups. There were higher rates of obstetric haemorrhage, acute kidney injury, cardiopulmonary events, infection, hypertensive disorders, maternal death, additional uterotonics, tranexamic acid, transfusion, and hysterectomy (all p < 0.05) among those who underwent CB versus VB. Infants born via CB were more likely to experience neonatal intensive care unit (NICU) admission and neonatal death (all p < 0.05) compared to VB group (Table 1). Urgent/emergent CB were associated with higher rates of hypertension, hemorrhage, infection, cardiopulmonary events, transfusion, uterotonics, tranexamic acid, hysterectomy, NICU admission, Apgar < 4 min at 5 mins, and neonatal death (all p < 0.05) compared to planned/routine CB without risk factors (Table 2).


Conclusion:

CB, especially for urgent/emergent indications, was associated with increased maternal and neonatal morbidity at a tertiary hospital in Botswana. Interventions to optimize CB outcomes are warranted.