{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T03:44:45Z","timestamp":1774583085051,"version":"3.50.1"},"reference-count":15,"publisher":"BMJ","issue":"7415","license":[{"start":{"date-parts":[[2003,9,11]],"date-time":"2003-09-11T00:00:00Z","timestamp":1063238400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2003,7,3]]},"published-print":{"date-parts":[[2003,9,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:bold>Objective<\/jats:bold>\n                    To examine potentially modifiable factors that may influence the high maternal and perinatal mortality associated with caesarean section in Malawi.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Design<\/jats:bold>\n                    A prospective observational study of 8070 caesarean sections performed between January 1998 and June 2000 and associated complications.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Setting<\/jats:bold>\n                    23 district and two central hospitals in Malawi.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Participants<\/jats:bold>\n                    45 anaesthetists from hospitals that carried out caesarean sections.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Main outcome measures<\/jats:bold>\n                    Associations between maternal or perinatal deaths in the first 72 hours and various quantifiable risk factors.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results<\/jats:bold>\n                    Questionnaires were returned for 5236 caesarean sections in district hospitals and 2834 in central hospitals; 7622 (94%) were emergencies, 5110 (63%) were because of obstructed labour. Preoperative haemorrhagic shock was present in 610 women (7.6%), anaemia in 503 (6.2%), and ruptured uterus in 333 (4.1%). Eighty five women died (1.05%), 68 of whom died postoperatively on the wards. Higher maternal mortality was associated with ruptured uterus (adjusted odds ratio 2.3, 95% confidence interval 1.3 to 4.0), little anaesthetic training (2.9, 1.6 to 5.1), general as opposed to spinal anaesthesia (6.6, 2.3 to 18.7), and blood loss requiring transfusion of \u22652 units (21.0, 11.7 to 37.7). Perinatal mortality up to 72 hours was 11.2% overall and was significantly associated with ruptured uterus and general rather than spinal anaesthesia.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion<\/jats:bold>\n                    In sub-Saharan Africa high maternal and perinatal mortality at caesarean section is associated with major preoperative complications that are unusual in developed countries. Improved training in anaesthetics, wider use of spinal anaesthesia, and improved surveillance and resuscitation in postoperative wards might reduce mortality.\n                  <\/jats:p>","DOI":"10.1136\/bmj.327.7415.587","type":"journal-article","created":{"date-parts":[[2003,9,11]],"date-time":"2003-09-11T21:07:08Z","timestamp":1063314428000},"page":"587","source":"Crossref","is-referenced-by-count":106,"title":["Caesarean section in Malawi: prospective study of early maternal and perinatal mortality"],"prefix":"10.1136","volume":"327","author":[{"given":"Paul M","family":"Fenton","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher J M","family":"Whitty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felicity","family":"Reynolds","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2003,9,11]]},"reference":[{"key":"2025122212400937000_327.7415.587.1","first-page":"33","article-title":"The epidemiology of district surgery in Malawi.","volume":"3","author":"Fenton","year":"1997","journal-title":"East Cent Afr J Surg"},{"key":"2025122212400937000_327.7415.587.2","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1136\/bmj.289.6437.92","article-title":"Incidence and estimated need of caesarean section, inguinal hernia repair and operation for strangulated hernia in rural Africa.","volume":"289","author":"Nordberg","year":"1984","journal-title":"BMJ"},{"key":"2025122212400937000_327.7415.587.3","first-page":"369","article-title":"Cesarean sections in Senegal: coverage of needs and quality of services.","volume":"8","author":"Cisse","year":"1998","journal-title":"Sante"},{"key":"2025122212400937000_327.7415.587.4","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1046\/j.1365-2044.1999.01060.x","article-title":"A study of requirements, amount given and effect on mortality.","volume":"54","author":"Fenton","year":"1999","journal-title":"Anaesthesia"},{"key":"2025122212400937000_327.7415.587.5","first-page":"234","article-title":"Post-natal maternal morbidity patterns in mothers delivering in Gweru City (Midlands province).","volume":"45","author":"Zishirir","year":"1999","journal-title":"Cent Afr J Med"},{"key":"2025122212400937000_327.7415.587.6","first-page":"367","article-title":"A review of maternal deaths in South Africa during 1998.","volume":"90","year":"2000","journal-title":"S Afr Med J"},{"key":"2025122212400937000_327.7415.587.7","first-page":"675","article-title":"Maternal mortality in the Thyolo district of Malawi.","volume":"69","author":"Chiphangwi","year":"1992","journal-title":"East African Med J"},{"key":"2025122212400937000_327.7415.587.8","unstructured":"National Statistical Office (Malawi) and ORC Macro . Malawi Demographic Health Survey, 1992. Zomba: National Statistical Office, 1993."},{"key":"2025122212400937000_327.7415.587.9","unstructured":"National Statistical Office (Malawi) and ORC Macro . Malawi Demographic and Health Survey 2000. Zomba: National Statistical Office of Malawi, 2001."},{"key":"2025122212400937000_327.7415.587.10","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/S0020-7292(01)00474-X","article-title":"Monitoring obstetric services: putting the \u201cUN guidelines\u201d into practice in Malawi: 3 years on.","volume":"75","author":"Hussein","year":"2001","journal-title":"Int J Gynaecol Obstet"},{"key":"2025122212400937000_327.7415.587.11","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-199802000-00010"},{"key":"2025122212400937000_327.7415.587.12","unstructured":"Better health in Africa: lessons and experiences learned. Washington, DC: World Bank, 1994. 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