Authors : Mahadi Taha Abd Elgadir; Sakeena Nour Eldine Salih; Ali Mohamed Ali Elimam; Omer Elgaili Yousef

Volume/Issue : Volume 10 - 2025, Issue 2 - February

Google Scholar : https://tinyurl.com/37vjtses

Scribd : https://tinyurl.com/bd5rp3mm

DOI : https://doi.org/10.5281/zenodo.14944840

Abstract : Background Emergency caesarean sections (ECS) are critical procedures performed to address urgent maternal or fetal conditions during childbirth. These interventions, although lifesaving, are associated with increased risks compared to planned caesarean sections. Maternal outcomes may include higher rates of infection, hemorrhage, and longer recovery periods, while fetal outcomes often involve respiratory distress, neonatal intensive care admission, and in some cases, perinatal mortality.  Objective: To asses fetomaternal outcomes of emergency caesarian sections at Bashair Teaching Hospital in 2022.  Methods: This study was an observational, descriptive, cross-sectional analysis conducted at Bashair Teaching Hospital in Khartoum, Sudan, from March to August 2022. It focused on patients who underwent emergency caesarean sections during this period, with a sample size of 124 participants selected via simple random sampling. Data was collected using structured questionnaires then analyzed using SPSS version 28.0, employing descriptive statistics and bi-variable analysis. Ethical approvals and participants consents were obtained, ensuring confidentiality and adherence to COVID-19 precautions.  Results: The study included 124 participants. The majority of participants were aged 20-29 years (39.5%), followed by those aged 30-39 years (33.1%). Almost half were from low socioeconomic backgrounds (49.2%), with 54.8% residing in urban areas. Education levels varied, with 33.1% having primary education, 31.5% secondary education, and 18.5% university education, while 16.9% were illiterate. More than half were housewives (55.6%), followed by officers (18.5%) and laborers (16.9%). Clinically, 57.3% of women received regular antenatal care, while 30.6% had irregular care, and 12.1% had no antenatal care. Common comorbidities included hypertension in(18.5%), anemia (7.3%), and diabetes mellitus (6.5%), 62.9% had no comorbidities. Pregnancy complications were prevalent, with previous scars being the most common (82.3%), followed by preeclampsia (8.9%) and pregnancy-induced hypertension (8.1%). The indications for emergency caesarean sections were previous scars in labor (38.7%), prolonged labor (21.0%), and malpresentation (14.5%). Maternal outcomes post-surgery were generally positive, with 87.9% of women discharged in good health, though 11.3% developed complications such as bleeding (5.6%), thromboembolism (3.2%), and postoperative pain (6.5%). Only 1.6% required ICU admission, and 15.3% needed blood transfusions. Neonatal outcomes showed that 73.4% of newborns had average birth weights, 20.2% were low birth weight, and 6.5% were large babies. Most were born at term (81.4%), with 8.9% preterm and 9.7% postdate. Apgar scores at 1 minute showed 58.9% scoring 7-10, while scores at 5 and 10 minutes revealed concerns, with 52.4% scoring 4-6 and 16.1% scoring 0-3 at 5 minutes, and 71.8% scoring 4-6 and 20.2% scoring 0-3 at 10 minutes. Overall, 83.9% of newborns were alive and well, 12.9% developed complications, and there were 4 stillbirths (3.2%). Of these, 50% were fresh stillbirths and 50% macerated. Common neonatal complications included respiratory distress syndrome (50.0%) and meconium aspiration syndrome (25.0%), with 13.7% requiring NICU admission.  Conclusion: Bedside specialist is needed to reduce maternal morbidity related to emergency cesarean section. Delayed decision delivery interval, low birth weight, meconium stained liquor and lack of good neonatal equipment facility are associated with poor neonatal outcome.

Keywords : Maternal, Fetal, Outcomes, Emergency, Caesarian Sections.

References :

1. Kawano S, et al. Emergency cesarean section. Masui. 2012 Sep; 61(9):917-23; 923-4.
2. Adam I. An epidemic of cesarean deliveries at Khartoum Hospital in Sudan with over two-fifths of neonates delivered through the 74 abdomen. J Women's Health Issues Care. 2013; 2(6):10.4172/2325-9795.1000126.
3. Kattel P, et al. Feto-maternal outcomes of emergency caesarean section following residential posting at Dhading District Hospital. JNMA J Nepal Med Assoc. 2018 Mar-Apr;56(210):587-592.
4. Erika, Leuva H, Leuva B, Kanani M. A study of caesarean section. Int J Reprod Contracept Obstet Gynecol. 2013; 2:320.
5. Gedefaw G, Demis A, Alemnew B, et al. Prevalence, indications, and outcomes of caesarean section deliveries in Ethiopia: a systematic review and meta-analysis. Patient Saf Surg. 2020; 14:11. https://doi.org/10.1186/s13037-020-00236-8
6. Ayano B, Guto A. Indications and outcomes of emergency caesarean section at St Paul's Hospital Medical College, Addis Ababa, Ethiopia: a four-month retrospective cohort study. Gynecol Reprod Health. 2018;2(5):1-12.
7. Yang XJ, Sun SS. Comparison of maternal and fetal complications in elective and emergency cesarean section: a systematic review and meta-analysis. Arch Gynecol Obstet. 2017;296(3):503-512. https://doi.org/10.1007/s00404-017-4427-7
8. van Ham MA, van Dongen PW, Mulder J. Maternal consequences of caesarean section: a retrospective study of intraoperative and postoperative maternal complications of caesarean 75 section during a 10-year period. Eur J Obstet Gynecol Reprod Biol. 2019;74(1):1-6. https://doi.org/10.1016/S0301-2115(97)02725-5
9. Karlström A, Lindgren H, Hildingsson I. Maternal and infant outcome after caesarean section without recorded medical indication: findings from a Swedish case-control study. BJOG. 2020;120(4):479-486. https://doi.org/10.1111/1471-0528.12129
10. McDonnell S, Chandraharan E. Determinants and outcomes of emergency caesarean section following failed instrumental delivery: 5-year observational review at a tertiary referral centre in London. J Pregnancy. 2015;2015:627810. https://doi.org/10.1155/2015/627810
11. Hillemanns P, Hasbargen U, Strauss A, Schulze A, GenzelBoroviczeny O, Hepp H. Maternal and neonatal morbidity of emergency caesarean sections with a decision-to-delivery interval under 30 minutes: evidence from 10 years. Arch Gynecol Obstet. 2021;268(3):136-141. https://doi.org/10.1007/s00404-003-0527-4.