Effect of mode of delivery on outcomes of full term neonates admitted in a tertiary Hospital of Kigali

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.