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Observational Study
. 2025 Mar;168(3):1210-1220.
doi: 10.1002/ijgo.15996. Epub 2024 Nov 2.

Long-term maternal outcomes 5 years after cesarean section in Sierra Leone: A prospective cohort study

Erika Logstein  1 , Richard Torp  1 , Thomas Ashley  2   3 , Michael M Kamara  4 , Alimamy P Koroma  5 , Abu Bakarr Dumbuya  6 , Musa S Suma  3 , Abdul Rahman Moijue  7 , Josien Westendorp  2   8 , Monica L Kujabi  9   10 , Marcus J Rijken  11 , Arne Wibe  12   13 , Lars Hagander  14 , Andrew J M Leather  15 , Håkon A Bolkan  2   8   12 , Alex J van Duinen  2   8   12   16
Affiliations
Observational Study

Long-term maternal outcomes 5 years after cesarean section in Sierra Leone: A prospective cohort study

Erika Logstein et al. Int J Gynaecol Obstet. 2025 Mar.

Abstract

Cesarean section (CS) is a life-saving procedure when performed for the right indication but carries substantial risks, specifically during subsequent pregnancies. The aim of this study was to evaluate obstetric outcomes for women 5 years after a CS performed by medical doctors and associate clinicians. This was a prospective multi-center observational study of women who had a CS at any of nine hospitals in Sierra Leone. Women and their offspring were followed up with three home visits for 5 years after surgery. Outcomes of interest included long-term complications, mode and place of delivery, and maternal and pediatric outcomes of subsequent pregnancies. Of the 1274 women included in the study, 140 (11.0%) were lost to follow-up. Within 5 years after the index CS, 27.0% of the women became pregnant and 2.5% had a second pregnancy. Women with perinatal death at the index CS had 5.25 higher odds of becoming pregnant within 1 year. Of the 259 women who delivered, 31 (12.0%) had a planned CS and 228 (88.0%) attempted a trial of labor after CS, resulting in either a successful vaginal birth (n = 138; 60.5%) or an emergency CS (n = 90; 39.5%). Peripartum and long-term complications did not significantly differ between those that were operated on by medical doctors and associate clinicians. Within 5 years after CS, one in four women became pregnant again and more than half had a vaginal delivery. Significant differences in place and mode of birth between wealth quintiles illustrate inequities.

Keywords: Sierra Leone; cesarean section; long‐term outcomes; trial of labor after cesarean section; vaginal birth after cesarean section.

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Conflict of interest statement

J.W., A.J.v.D. and H.A.B. are unpaid board members and T.A. is an employee of CapaCare, the NGO organizing the surgical training program for medical doctors and community health officers in Sierra Leone in collaboration with the Ministry of Health and Sanitation. A.P.K. has received allowance for conducting examinations, and T.A., M.M.K., and A.R.M. are former students of this program.

Figures

FIGURE 1
FIGURE 1
Study flowchart. The dotted line represents women who were initially not found during one or two home visits but were retrieved during a later home visit.
FIGURE 2
FIGURE 2
Kaplan–Meier survival curves for time to first and second pregnancies in the first 5 years after cesarean section (CS).
FIGURE 3
FIGURE 3
Kaplan–Meier survival curves for time to first pregnancy after cesarean section (CS) for women by perinatal outcome of the index CS.
See this image and copyright information in PMC

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