Risk factors associated with maternal complications of caesarean delivery in Rwanda: a retrospective cross-sectional study

BACKGROUND: The global prevalence of Caesarean Section (CS) has significantly risen from 7% in 1990 to 21% in 2018, rising suspicion of unnecessary use of caesarean section based on WHO recommendations. In Rwanda, CS rates have significantly increased from 2.2% in 2000 to 15.6% in 2020, with nearly half of maternal deaths reported to be associated with caesarean deliveries. However, predictors of maternal complications of CS have not yet been studied in large scale, therefore, this study aimed to determine the risk factors associated with maternal complication of CS in Rwanda. METHODS: A retrospective cross-sectional study was conducted in 16 hospitals located in the Northern, Southern, and Western provinces, as well as the City of Kigali, in Rwanda. Data collection checklist was developed based on criteria-based clinical audits (CBCA). CBCA is used in conducting clinical audits of caesarean section indications. The outcomes of 3,982 women who underwent CS over a one-year period were analyzed. Maternal complication of CS was defined as the presence of at least one intraoperative or postoperative surgical complications. Multivariate logistic regression analysis was performed to assess the factors associated with maternal complication of CS at significant level of p-value < 0.05. RESULTS: Findings revealed that 142(3.6%) women experienced complications following CS and the most common complication of CS was postpartum hemorrhage (73%). Nearly half of the women were aged between 25 and 34 years and had no history of previous caesarean section. Women aged ≥ 35 years had an increased risk of CS complications compared to those under 25 years (Adjusted odds ratio, AOR = 3.34; 95% CI: 1.460–7.644). Having two or more prior CS was identified as a risk factor for CS complications (AOR = 1.80; 95% CI: 1.083–3.021, P = 0.024). Hypertension was significantly associated with an increased risk of maternal complications of CS (AOR = 1.71; 95% CI: 1.092–2.678, P = 0.019). CONCLUSIONS: Prevalence of maternal complication of cesarean delivery was unduly low. Significant risk factors such as advanced age, previous CS, complications during pregnancy and hypertension were observed. During antenatal care visits, healthcare providers should inform mothers about the short-and long-term health problems associated with unnecessary CS.