Post caesarean section complications in women infected with COVID-19 disease

Maboko, Rendani

Post caesarean section complications in women infected with COVID-19 disease

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Obstetrics and Gynaecology

Faculty

Faculty of Health Sciences

Abstract

Background: The COVID-19 pandemic had a multifaceted impact on maternal health and pregnancy outcomes. This study aimed to determine the impact of the COVID-19 on caesarean section outcomes in pregnant women with COVID-19 infection in South Africa. Objective: To evaluate post-operative outcomes in women who were diagnosed with COVID-19 infection, who underwent a caesarean section delivery while hospitalized in South Africa, during the pandemic. Methods: A secondary analysis was conducted on data from a multicentre national database by the International Network of Obstetric Survey Systems (INOSS). The dataset included hospitalized pregnant women diagnosed with the COVID-19 disease between 14 April 2020 and 9 December 2021 in South Africa. Statistical analyses were performed to determine the association between mode of delivery, postoperative complications and mortality. Results: Among 456 women who delivered by caesarean section. Complications were seen in 74 of 456 (16.2%) women. There was a statistically significant association between caesarean delivery and post-operative complications (p = 0.04). Mortality in COVID-19 positive women undergoing caesarean was 6.1%. Elective caesarean sections (9.02%) were associated with a notably higher rate of mortality compared to emergency procedures (2.5%). Notably 71.4% of maternal deaths amongst those who delivered by caesarean section were due to COVID-19 related respiratory complications. Conclusion: Caesarean section in COVID-19 positive women was associated with increased postoperative complications, especially in the elective cases. Mortality in this cohort was mainly due to respiratory complications. These findings suggest the need for more refined clinical protocols and careful surgical decision-making during pandemics, especially in resource constrained settings.