Anaesthetic related peri-operative complications during Caesarean delivery at the University Teaching Hospital, Lusaka,Zambia

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. Two hundred and forty six (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, 5 cases (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. There was a significant association between Mallampati and failed intubation (p value= 0.012). 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.