In-facility maternal deaths with and without caesarean section in Sierra Leone in 2016
| With caesarean section | Without caesarean section | P value | |
| n=99 | n=438 | ||
| Age | |||
| Median (IQR) | 27 (20–32) | 27 (21–32) | 0.76* |
| <15 | 14 (14%) | 71 (16%) | |
| 15–24 | 24 (24%) | 88 (20%) | |
| 25–34 | 44 (44%) | 190 (44%) | |
| ≥35 | 17 (17%) | 86 (20%) | |
| Unknown | 0 (0%) | 3 (0.7%) | |
| Gravidity | |||
| Median (IQR) | 3 (1–5) | 3 (2–6) | 0.10* |
| 1 | 25 (26%) | 86 (24%) | |
| 2–5 | 56 (58%) | 197 (54%) | |
| ≥6 | 16 (16%) | 81 (22%) | |
| Unknown | 2 (2%) | 74 (17%) | |
| Parity | |||
| Median (IQR) | 2 (0–4) | 3 (1–5) | 0.005* |
| 0 | 25 (26%) | 57 (19%) | |
| 1–4 | 56 (58%) | 156 (53%) | |
| ≥5 | 15 (16%) | 80 (27%) | |
| Unknown | 3 (3%) | 145 (33%) | |
| Number of antenatal care visits | |||
| Median (IQR) | 3 (2–3) | 3 (1–3) | 0.55* |
| 0 | 6 (11%) | 30 (13%) | |
| 1 | 4 (7%) | 31 (13%) | |
| 2–3 | 36 (64%) | 121 (51%) | |
| ≥4 | 10 (18%) | 56 (24%) | |
| Unknown | 43 (43%) | 200 (46%) | |
| Referred from | <0.001† | ||
| Other hospital | 2 (2%) | 6 (2%) | |
| Peripheral health unit | 51 (56%) | 89 (33%) | |
| Home | 39 (43%) | 173 (65%) | |
| Unknown | 7 (7%) | 170 (39%) | |
| Time from admission to death | |||
| Median (IQR) number of days | 1.0 (0.3–3.7) | 0.7 (0.2–2.3) | 0.02* |
| Unknown | 1 (1%) | 144 (33%) | |
| Time from start of operation to death | |||
| Median (IQR), hours, n=95 | 9.5 (4.4–81.5) | N/A | |
| Unknown | 4 (4%) | N/A | |
| Intraoperative findings | |||
| Uterine rupture | 23 (22%) | N/A | |
| Placental abruption | 11 (10%) | N/A | |
| Cause of death‡ | |||
| Haemorrhage | 64 (73%) | 184 (44%) | <0.001§ |
| Hypertensive disorders | 20 (23%) | 72 (17%) | 0.29§ |
| Sepsis | 12 (14%) | 47 (11%) | 0.58§ |
| Embolism | 1 (1%) | 0 | 0.32§ |
| Other direct causes | 0 | 19 (5%) | 0.03§ |
| Indirect causes | 11 (12%) | 93 (22%) | 0.04§ |
| Abortion | 0 | 12 (3%) | 0.14§ |
| Unknown | 11 (11%) | 24 (5%) | |
| Fetal death¶ | |||
| Number of stillbirths (proportion) | 44 (59%) | 95 (46%) | 0.06§ |
| Unknown | 25 (25%) | 232 (53%) |
*Mann-Whitney U test.
†χ2 test.
‡Categories according to Say et al,2 several contributing causes of death were noted for some patients.
§Fisher’s exact test.
¶Fetal death included cases of death of one of two twins, and undelivered fetuses, and molar pregnancies were excluded; percentages may add up to above 100% due to rounding or patients appearing in multiple categories.
N/A, not applicable.