BMJ  2003;327 (13 September), doi:10.1136/bmj.327.7415.0-d

Small changes can improve survival after caesarean section in Africa

Simple measures could reduce mortality associated with caesarean section in sub-Saharan Africa. In a study of over 8000 caesarean sections in Malawi, Fenton and colleagues (p 587) found that haemorrhagic shock, anaemia, and ruptured uterus were common. The most common indication for caesarean section was obstructed labour. Eighty five women died, most of whom died on the postoperative wards. Perinatal mortality was 11% up to 72 hours. Maternal deaths were associated with blood loss but not with lack of available blood transfusion. The use of general rather than spinal anaesthesia and inadequate training of the anaesthetist were also associated with maternal and perinatal mortality. The authors say that improved training in anaesthesia and postoperative surveillance might reduce mortality.

Credit: TRYGVE BOLSTAD/PANOS

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