• Archana Shah, Bukola Fawole, James Machoki M'imunya, Faouzi Amokrane, Idi Nafiou, Jean-José Wolomby, Kidza Mugerwa, Isilda Neves, Rosemary Nguti, Marius Kublickas, and Matthews Mathai.
• Department of Making Pregnancy Safer, World Health Organization, Geneva, Switzerland. shaha@who.int
• Int J Gynaecol Obstet. 2009 Dec 1; 107 (3): 191-7.

ObjectiveTo assess the association between cesarean delivery rates and pregnancy outcomes in African health facilities.MethodsData were obtained from all births over 2-3 months in 131 facilities. Outcomes included maternal deaths, severe maternal morbidity, fresh stillbirths, and neonatal deaths and morbidity.ResultsMedian cesarean delivery rate was 8.8% among 83439 births. Cesarean deliveries were performed in only 95 (73%) facilities. Facility-specific cesarean delivery rates were influenced by previous cesarean, pre-eclampsia, induced labor, referral status, and higher health facility classification scores. Pre-eclampsia increased the risks of maternal death, fresh stillbirths, and severe neonatal morbidity. Adjusted emergency cesarean delivery rate was associated with more fresh stillbirths, neonatal deaths, and severe neonatal morbidity--probably related to prolonged labor, asphyxia, and sepsis. Adjusted elective cesarean delivery rate was associated with fewer perinatal deaths.ConclusionUse of cesarean delivery is limited in the African health facilities surveyed. Emergency cesareans, when performed, are often too late to reduce perinatal deaths.

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