Abstract:
BACKGROUND: Annually, there have been 147,183,065 deliveries or (20 births per 1000
populations) worldwide and 37 births per 1000 population in sub-Saharan region. Nowadays,
there is a great deal of controversy regarding the optimal mode of delivery in some situations.
However, the neonatal outcomes depend either on maternal factors, health system, the neonates
or the mode of delivery itself. Cesarean section has been shown to be beneficial to the newborn
when medically indicated, for instance timed delivery, less risk of birth trauma and asphyxia
worldwide, but can also cause some complications. This study aimed at assessing the effect of
mode of delivery on outcomes of full term neonates in University Teaching Hospital of Kigali
(CHUK).
METHODS: This retrospective cohort study includes all full term neonates born on single
pregnancy at CHUK and admitted in NICU from January 1stto December 31st, 2016.We
described neonates‟ demographics, clinical characteristics and health history; and outcomes. The
incidence rates and estimation risk of outcomes were calculated; the association between
neonatal outcomes and mode of delivery was assessed using univariate analysis and chi- square
test.
RESULTS: In 2016, 185full term neonates were enrolled. The most common mode of delivery
was cesarean section (68.6%) followed by spontaneous vaginal delivery (31.4%). The neonatal
mortality was associated significantly with time from birth to NICU admission and reasons of
admissions (p<0.001). However, no association proven between neonatal mortality and mode of
delivery (P=0.545).The overall in hospital complications was 44.3%; majority being sepsis
(23.2%) and jaundice (15.1%). The in hospital mortality rate was 7%. 2.6% of death is
attributable to birth trauma (AR=0.026), whereas 3% of post-delivery morbidity is attributable to
v
C/S delivery (AR=0.03, RR=1.04). 19% of birth trauma is attributable to the mode of delivery
(AR=0.19, RR=1.2). Respiratory complications are more common in C/S than SVD (AR=0.7,
RR=3.7) CONCLUSION: The mode of delivery or process of delivery itself can be a
confounding factor on neonatal outcomes. We need to early identify the neonates who need
assistance and support them.
