Anaesthetic Related Peri-Operative Complications During Caesarean Delivery at the University Teaching Hospital, Lusaka, Zambia
Keywords:
Frequency, anaesthesia, perioperative, caesarean
Abstract
Background: Caesarean deliveries are increasingly performed at the University Teaching Hospital (UTH), Lusaka, with a 2012 audit report indicating a rate of 17.8%.The procedure is a major surgical intervention and results in higher morbidity than vaginal delivery. Part of this morbidity and mortality during caesarean delivery is that resulting from the anaesthesia relating to the surgery. However, information on the extent of anaesthetic related complications associated with caesarean deliveries in low resource settings such as at UTH is lacking. This study endeavored to explore this aspect. Objective: To determine the frequency of anaesthetic related perioperative complications during caesarean delivery at the UTH, Lusaka, Zambia Study Design: A prospective observational study documenting the anaesthetic related complications in women undergoing caesarean delivery at UTH. 246 consecutive parturients undergoing caesarean deliveries were enrolled in the study. Methodology: All women who presented for caesarean delivery at UTH in Lusaka, Zambia from January 12, 2014 to July 12, 2014 and met the inclusion criteria were recruited into the study. Information on the patient and her management was obtained from the patient’s medical records. Participants were followed up from the time they were taken into theatre, during the procedure until the time they left the recovery room post operatively, and any complication observed was documented. Hypotension, possible aspiration, failed intubation, conversion from spinal to general anaesthesia, severe hypoxemia and death were the main outcome measures. A descriptive analysis was performed. All significant variables were included in the final multivariable logistic model. All tests were set at 95% confidence interval (CI) and a P- value of <0.05 was considered statistically significant. Results: No mortality was recorded out of the 246 parturients enrolled for the study. The average age was 28 years.Thirty-four cases (13.8%) received general anaesthetic while 212 cases (86.2%) had spinal anaesthetic. Obstructed labour 79 cases (32.1%) and previous caesarean sections 68 cases (27.6%) were among the indications for caesarean deliveries. Perioperative complications recorded included, 172 cases (69.9%) of hypotension, 6 cases (11.1%) had failed intubation, 5cases (9.3%) possibly aspirated, 20 cases (9.4%) had failed spinal technique needing conversion to general anaesthetic, 6 cases (3.1%) had high spinal block. Severe hypoxemia intraoperatively and postoperatively was noted in 16 cases (6.5%) and 7 cases (2.8%) respectively. There were no statistically significant associations among the complications with age of parturients, ASA status, grade of anaesthetist, category of caesarean sections, indication for caesarean sections or gestational age. Conclusion: There are many anaesthetic related complications during caesarean sections occurring at UTH. Future studies are needed to solely look into factors contributing to each of the complication at UTH.References
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2. Michael S Avidan, Phillipa Groves, Margaret Blott. Low complication rate associated with CS under spinal anaesthesia for HIV 1-infected women on anti-retroviral therapy. Anesthesiology 2002; vol97:320-324
3. Onwuhafua P I,Onwuhafua A, Adze J.The challenge of reducing maternal mortality in Nigeria.Int Journal of Gynaecol Obstetric 2000;71: 211-213
4. Kampikahio A ,Irwig L M. Incidence and causes of maternal mortality in five Kampala Hospitals 1980-1986.East Afr Med J 1991; vol68: 624-631
5. Ujah I A O,Uguru V E,Aisien A O,SagayAS,Otubu J A M.How safe is motherhood in Nigeria? The trend of maternal mortality in a tertiary health institution. East Afr Med J 1999;76: 436-439
6. Sule-Odu A O.Maternal deaths in Sagamu,Nigeria. Int J GynaecolObstet 2000;69:47-49
7. A F Ouro-Bangna,Maman M D,K Tomta M D.Death associated with Anaesthesia. Tropical doctor Oct 2005; vol 35: 220-222
8. Reynolds F.Maternal Mortality-Anaesthesia in perspective.SOAPnews letter 1993;24: 5-8
9. Lewis G. (ed). The Confidential Enquiry into Maternal and child health (CEMACH).Saving mothers lives reviewing maternal deaths to make motherhood safer 2003-2005,2007
10. Wee M Y K,BrownH,ReynoldsF.The National Institute of clinical Excellence(NICE) guidelines for caesarean sections:implications for the anaesthetist.Int J ObstetAnaesth 2005;14:147-158
11. Heywood A J, Wilson I H, Sinclair J R. Peri operative mortality in Zambia. Annals of the royal college of surgeons of England 1989; vol 71: 354-358
12. McKenzie G. Mortality associated with anaesthesia at Zimbabwean teaching hospitals. South African medical journal 1996;vol86: 338-342
13. National committee on confidential enquiry into maternal deaths, saving mothers-report of confidential Enquiry into maternal deaths in SA 2002-2004
14. Steven L. Bloom, Catherine Y Spong,Steven J Weiner. Complications of Anesthesia for caesarean delivery.Int J Obstetric Gynaecol 2005;106: 281-287
15. Ahmed Y,Mwaba P, Chintu C et al. A study of maternal mortality at the University Teaching Hospital, Lusaka, Zambia: The emergency of TB as a major non obstetric cause of maternal death. Int J Tuberc Lung Dis 1999; vol3: 675-680
16. Menendez C, Romagosa C, Ismail M,et al. An autopsy study of maternal mortality in Mozambique: the contribution of Infectious diseases.Plos med 2008; vol 5: 44
17. Chobli. Reduce morbidity and mortality in anaesthetic developing countries; focus on obstetric surgery, Annal for AnaesReanin 1999; vol18: 619-620
18. AndriamadyRasorimahandry, CL Rakotoarimanana, M Ranjalahy RJ. Maternal Mortality in the Maternity ward of Befelatanama,University hospital of Antananarivo.Int J Obstetric Gynecology 2000; vol29: 501-508
19. Lyons G. Saving mothers lives: Confidential Enquiry into Maternal and Child Health 2003-2005. Int J Obstetric Anaest 2008; vol 17: 103-108
20. Cooper G M & Mc Clure J.H, Anesthesia Chapter from saving mothers reviewing maternal deaths to make pregnancy safer. Brit J Anaes 2008; vol 100: 17-22
21. Joy L,Hawkins M D,Lisa M, Koonin M N. Anaesthesia-related Deaths During Obstetric Delivery in the United States,1979-1990.Anaesthesiology 1997;86:277-84
22. Enohumah K O &Imarengiaye CO. Factors associated with anaesthetic related maternal mortality in a tertiary hospital in Nigeria.ActaAneasthesiascand 2006;vol 50: 206-210
23. Fenton PF,Whitty CJ & Reynolds F.Caesarean Section in Malawi; Prospective study of Early maternal and perinatal mortality.Brit Med J 2003; vol 327:587-590
24. McKenzie AG. Operative Mortality at Harare Central Hospital.1992-1994:Ananaesthetic view. Int J Obst anaesthesia1998; vol 7: 237-241
25. N.J Mc Donnel,M J Paech,O.MClavis,K L Scott.Difficult and Failed Intubation in Obstetric Anaesthesia.University of Western Australia and Department of Anaesthesia and Pain Medicine 2008.
26. Ngan Kee WD. Confidential Enquiries into maternal deaths:50 years of closing the loop.Bri J Anaes 2005; 413-416
27. BarnadoPD , Jenkins JG, Failed tracheal intubation in obstetric: a 6 yr review in a uk region. Anaesthesia 2000; vol 55: 690-694
28. Lyons G. Failed intubation .Six years experience in a teaching maternity unity. Anaesthesia1985; vol 40:757-762
29. Rout C.Maternal mortality and Anesthesia in Africa:A South African perspective. International journal of ObstetAnaest 2002;vol 11:77-80
30. Edomwonyi N.P, Osaigbovo P.E. Incidence of Obesity in Parturients scheduled for Caesarean, intra-operative complications, management and outcome. East African medical journal April 2006; vol 83: No. 4
31. SngB.L,LimY,Sia A.T.H. An observational prospective cohort study of incidence and characteristics of failed spinal anesthesia for caesarean section. International journal of obstetric anaest 2009; vol 18: 237-241
32. S.W.Husaini, I.F.Russel. Volume Preload; Lack of effect in prevention of spinal-induced hypotension at caesarean section. International journal of obstetric anesthesia 1998;7:76-81
33. Royal college of Anaesthetist.Technique of Anaesthesia for caesarean section 2011.In Raising the standard,a compendium of Audit Recipes
34. Simwaka B N,TheobaldS,Amekudzi Y P,Tolhurst R. Meeting Millenium Development Goals 3 and 5.BMJ 2005;331:708-709
35. Garry M,DaviesS.Failure of regional blockade for caesarean section.Int J obstetAnaesth 2002;11:9-12
36. Jenkins J.G,KhanM.M.Anaesthesia for caesarean section;a survey in uk region from 1992 to 2002,Anaesthesia 2003;53:1114-8
37. Kinsella S.M. Aprospective audit of regional anaesthesia failure in 5080 caesarean sections,Anaesthesia 2008;63:822-832
38. Lucas D.N,YentisS.M,Kinsella S.M et al.Urgency of Caesarean Section:A new classification.J.R.Soc med 2000;93:346-50
Published
2021-01-28
How to Cite
1.
Chakana C, Kinnear J, Bould D. Anaesthetic Related Peri-Operative Complications During Caesarean Delivery at the University Teaching Hospital, Lusaka, Zambia. University of Zambia Journal of Agricultural and Biomedical Sciences [Internet]. 28Jan.2021 [cited 3Jul.2024];4(4). Available from: https://journals.unza.zm/index.php/JABS/article/view/344
Section
Biomedical Sciences