Caesarean Delivery at a Teaching Hospital, South-South Nigeria: A Five-Year Review

Objectives: To determine the rate, indications, outcome and complications of caesarean sections in a tertiary health facility.

Materials and Methods: A retrospective study of all caesarean sections carried out at the obstetric unit of the University of Port Harcourt Teaching Hospital, (UPTH) Nigeria, between January 1, 2011 and December 31, 2015 was conducted. Data was obtained from the theatre records and case notes of patients, and were analysed using the statistical package SPSS 20.

Results: Over the 5-year period under review, there were 12,421 deliveries. The overall caesarean section rate was 30.3%. There were 2,780 (73.8%) emergency caesarean sections and 987 (26.2%) elective caesarean sections. Feto-pelvic disproportion was the commonest indication for caesarean section 1049 (27.8%), followed by repeat caesarean section (16.7%). Anaemia was the commonest postoperative complication, occurring in 488 (19%) women, followed by pyrexia in 241 (9.6%) and wound infection 104 (3.7%). There were 4 cases of maternal deaths recorded in the study period giving a case fatality rate of 0.1%. Three of these four maternal deaths followed emergency caesarean section. Majority of the babies 2,799 (74.3%) were delivered by emergency procedure.

More than half of the babies 1,584 (41.4%) had birth asphyxia and there were 231 (6%) perinatal deaths. All the cases of perinatal deaths were following emergency procedure.

Conclusion: The CS rate in this study is high. Feto-pelvic disproportion was the most common indication. The perinatal outcome following emergency caesarean section is poor. Risk appraisal and efforts geared towards reducing caesarean section rate especially in our environment where subsequent deliveries might not be attended to by skilled health personnel must be done.