Risk factors for maternal mortality among women who had a caesarean section delivery in Kenya: a case-control study.

Objectives: To determine the risk factors associated with caesarean section (CS)-related deaths in Kenya.

Design: We used a case-control study design with a sample size of 360 (80% power) women who had CS in 2014. Fully adjusted and parsimonious odds ratios (OR) with 95% confidence intervals (CI) and significance levels (p-value ≤0.05) was reported based on multiple regression analysis.

Setting: 96 Kenya referral hospitals.

Outcome measures: The dependent variable was death after CS, while the independent variables were sociodemographic factors, antenatal care profile indicators, clinical parameters, and post-CS management.

Results: Patient referral (OR 2.68, 95% CI:1.22-5.89), postpartum hemorrhage (OR 27.50, 95% CI:8.40-90.13), blood transfusion (OR 14.59, 95% CI: 3.95-53.91), referral to Intensive Care Unit (OR 27.50, 95% CI:8.40-90.13), and general anesthesia use (OR 11.45, 95% CI:4.56-28.74), were the risk factors for death amongst women who had CS.

Conclusion: Mitigating these risk factors by prioritizing interventions that include early identification and treatment of women at risk of postpartum

haemorrhage, use of regional anaesthesia where possible, CS performed by experienced staff, early referral and adequate blood transfusion services, are likely to improve the quality of care.