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Why African mothers are 50 times more likely to die after C-section

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*Procedure associated with higher risk of severe complications for women above 35 years
*Children born via IVF have greater chance of developing childhood cancer, study finds

African mothers who give birth by Caesarean section are 50 times more likely to die after the procedure than women living in high-income countries, according to a new study.The study, published in the journal Lancet Global Health, found that the maternal mortality rate in African countries was “substantially higher than expected”: 5.43 deaths per 1,000 operations, compared with 0.1 deaths per 1,000 operations in the United Kingdom (U.K.).

Similarly, one in six African women experienced complications during caesarean surgery, three times the rate of women in the United States.Bruce Biccard, an anesthesiologist and professor at the University of Cape Town who led the research, said that three-quarters of the women in the study had an emergency C-section. “Women can’t access care easily, and when they do, they end up in a health care facility that’s often inadequate,” he said.

The research studied 3,684 women who had elective and non-elective cesarean deliveries, using data from 183 hospitals across 22 countries in Africa. It formed part of the African Surgical Outcomes Study, which measured the outcomes of all patients who received surgery during a seven-day period between February and May 2016.

Caesarean section is a surgical procedure in which a child is removed through a surgical opening in the mother’s lower abdomen rather than birthed through the vaginal canal. Procedures can be planned, but many occur when unexpected childbirth problems arise, putting the mother’s and/or the infant’s life at risk.Mothers in sub-Saharan Africa are far less likely to give birth via C-section than elsewhere in the world, where C-sections have been on the rise. Biccard said it was important to increase access to the procedure in parallel with improving the safety of C-sections in Africa.

The results of the study underscored the need for more specialist surgical, obstetrical and anesthetics care, Biccard said.The study found that there was an average of 0.7 specialists per 100,000 people in the countries in the study. Biccard said that figure should be at least 22 per 100,000 people to obtain a safe minimum standard.

The study had some limitations, the authors noted, with a disproportionate number of participating hospitals university-affiliated rather than district hospitals, which act as first-level providers of care for most African women and typically have fewer resources. Also, two-thirds of patients were from middle-income countries, where better levels of care are available than in Africa’s poorest countries.

According to new research published in CMAJ (Canadian Medical Association Journal), Caesarean delivery is associated with a higher risk of severe complications for the mother compared with vaginal delivery, especially in women aged 35 and older. An obstetrician and epidemiologist with the Robert Debre Hospital and INSERM, Paris, France, Dr. Diane Korb, said: “These results have implications for clinical practice and will be useful in deciding the type of delivery. Physicians must consider this increased risk when determining the best way to deliver, especially for older mothers.”

Rates of caesarean delivery have increased dramatically over the last 20 years, with more than one in five women delivering by caesarean, often for medically questionable reasons.Although observational studies on cesarean delivery exist, the results may be influenced — confounded — by the health condition that required the cesarean rather than the surgical procedure itself.

Meanwhile, children born through In Vitro Fertilisation (IVF) have a greater risk of developing childhood cancer, the largest study of its kind has found.Researchers in the United States (US) found that the risk of childhood cancer increases from 1.9 cases in 10,000 youngsters to 2.5 in those born through fertility treatment, an increase of around 31 per cent. Although the study is only observational, previous research has suggested that drugs used to stimulate the ovaries to produce eggs during fertility treatment, or the nutritious chemical soup in which embryos are grown may cause disease. The increased risk may also be caused by issues linked to the underlying infertility.

In the past three decades, in vitro fertilization (IVF) has gone from an experimental procedure to being more common. Pregnancies enabled by IVF frequently have more difficulties, with children born earlier and smaller even among singleton births. University of Minnesota researchers conducted the largest study of childhood cancer after conception by IVF to date. This population-based cohort study had nearly 2.5 times the number of children conceived by IVF than prior studies of the subject in Scandinavia and the United Kingdom. The results were recently published in JAMA Pediatrics.

Researchers first linked records of live births reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System between 2004 and 2013 to the birth and cancer registries of 14 states, comprising 66 percent of births in the United States and 75 percent of IVF-conceived births. These records were then linked to the cancer registries of the same states to find cancers diagnosed between 2013 and 2015. Researchers then randomly selected 10 children conceived naturally for each child conceived by IVF. The final dataset consisted of 275,686 IVF children and 2,266,847 naturally conceived children.

The study found: the overall cancer rate (per 1,000,000 children) of IVF children was about 17 percent higher than for non-IVF children; the rate of hepatic tumors was over 2.5 times higher among IVF children than non-IVF children; the rates of other specific cancers did not differ between the two groups; and there were no associations of childhood cancer with specific IVF treatment techniques.“The most important takeaway from our research is that most childhood cancers are not more frequent in children conceived by IVF,” said Logan Spector, a professor in the Medical School and Masonic Cancer Center member. “There may be an increased risk of one class of cancers in children; however, due to the nature of our study, we could not distinguish between IVF itself versus the parents’ underlying infertility. Overall, these results are reassuring to parents who’ve had children through IVF.”


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