"Primary Cesarean Section and Associated Maternal and Fetal Outcomes: A Cross-Sectional Analysis from Omdurman Maternity Hospital"

Primary cesarean section (CS) remains a critical intervention in obstetric care, particularly in low-resource settings. This study investigates the prevalence, indications, and maternal and neonatal outcomes of primary CS at Omdurman Maternity Hospital, Sudan. A cross-sectional analysis was conducted on 20,269 deliveries from December 2017 to December 2018. Of these, 1,196 women underwent primary CS. Emergency procedures accounted for 86.6%. Leading indications included fetal distress (17%), prolonged labor (13.8%), and breech presentation (11.2%). Clinical and sociodemographic data were analyzed using descriptive statistics and logistic regression. Among the 1,196 primary CS cases, 51.1% involved multiparous women. Maternal morbidity included intraoperative blood loss >1500 ml (1.4%) and transfusion need (8.1%), both significantly associated with adverse outcomes (OR = 2.94; p = 0.005 and OR = 3.31; p = 0.002, respectively). Neonatal outcomes showed a 96.3% live birth rate; however, 15.7% required NICU admission. Prolonged NICU stay was a significant predictor of poor neonatal trajectory (OR = 1.76; p = 0.031). Educational attainment was protective—women with secondary or higher education had reduced NICU admissions and mortality, while illiterate mothers faced greater risk (7.5% mortality). Emergency CS and low maternal education were significant predictors of neonatal compromise. Mapping surgical indications to outcomes supports improved risk stratification. Strengthening antenatal screening, labor monitoring, and public health education is essential to enhance maternal and neonatal safety in similar healthcare environments.