Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Martin, Janet

Abstract

Universal access to safe caesarean section is vital. The objective of this thesis was to quantify the risks of maternal and neonatal mortality, and causes of caesarean-related deaths.

Our initial systematic overview of pre-existing meta-analyses found no interventions that significantly reduced the risk of all-cause maternal or neonatal mortality. However, many interventions have been understudied.

Our systematic review and meta-analysis of 196 studies identified that the risk of perioperative maternal mortality has decreased over time and according to country development index, and the risk of perioperative neonatal mortality has fluctuated. We also found that the proportion of reported causes of caesarean-related deaths due to pregnancy-related infection and non-obstetric complications have decreased while obstetric haemorrhage and hypertensive disorders have increased over the past 70 years. Initiatives to reduce perioperative neonatal mortality and caesarean-related deaths due to obstetric haemorrhage and hypertensive disorders should be a global priority.

Summary for Lay Audience

Throughout the world, 18.5 million caesarean sections are performed every year. Compared to other forms of delivery, caesarean sections have higher risks of complications, including death of the mother and newborn. The rates of caesarean sections have been increasing globally and are more frequent in high resource countries. Additionally, maternal mortality has been found to be higher in low resource settings. This study aims to provide a better understanding of maternal and neonatal death during or after caesarean section over time and by country development status, through comprehensive systematic searches of prior studies and analyses. Our first study summarized the findings from 20 prior systematic research studies and found that none of the treatments or strategies assessed in the pooled analyses resulted in a lower risk in maternal or neonatal mortality during or after caesarean section. The subsequent study, which pooled the findings from 196 previous studies, determined that the risk of mothers dying during or following caesarean section reduced over time, whereas the risk of neonatal death after caesarean section showed no change over time. Furthermore, there was a relationship between the risk of mothers dying during or following caesarean section and country development status. In our final study, we found that the proportion of maternal deaths during or after caesarean section due to obstetric haemorrhage and hypertensive disorders increased over the past 70 years, and maternal deaths due to pregnancy-related infection and non-obstetric complications decreased over time. Additionally, deaths attributed to obstetric haemorrhage were higher in countries with low development status. By identifying areas that need improvement, adverse maternal and neonatal outcomes after caesarean section may be enhanced.

Available for download on Wednesday, September 01, 2021

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