Caesarean section for stillborn babies, Benin, Malawi, Uganda and United Republic of Tanzania
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World Health Organization
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This research article investigates caesarean section rates and indications among stillbirths in 16 hospitals across Benin, Malawi, Uganda and the United Republic of Tanzania using registry data collected between July 2021 and June 2023. The study analyses births of babies weighing at least 1000 g and examines the association between fetal heartbeat status at hospital admission and delivery by caesarean section. Given that caesarean birth is generally not recommended after confirmed fetal death unless maternal indications are present, the study explores factors that may contribute to caesarean section use among antepartum and intrapartum stillbirths in low-resource settings.
The findings show that caesarean section rates were substantial among stillbirths, particularly intrapartum stillbirths. Previous caesarean section was among the most frequently reported indications across birth outcomes, while fetal death was commonly reported as an indication among antepartum stillbirths. Absence of documented fetal heartbeat information at admission was associated with higher odds of caesarean section among both antepartum and intrapartum stillbirths. The authors discuss how diagnostic uncertainty, limitations in fetal monitoring and challenges in implementing monitoring recommendations may influence clinical decision-making. The study highlights the need for improved understanding of delivery decision-making processes and for feasible fetal monitoring guidance adapted to low-resource settings.
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