Trends, pattern and outcome of caesarean section at Lagos University Teaching Hospital, Lagos, Nigeria: A ten-year review

Abstract

Background: Caesarean section (C/S) rate and pattern of indications can be a reflection of maternal health status and quality of medical practice. This study aimed at determining current C/S rate at Lagos University Teaching Hospital (LUTH) and to assess trend, pattern and outcome of C/S in the last ten years.

Study design: A cross sectional study of all cases of C/S ≥28 weeks gestational age performed at LUTH from January 1, 2008 to December 31, 2017. Information which included maternal age, parity, gestational age at delivery, booking status, type of C/S and indications was retrieved from Labour Ward register using an electronic database. Data analysis was done with IBM SPSS version 23.

Results: A total of 12,811 deliveries that met the inclusion criteria during the study period were reviewed. Overall C/S rate was found to be 51.3% and there has been an increase over the years (p = 0.000). Commonest indications were previous C/S, HIV infection, hypertensive disorders, fetal distress and antepartum haemorrhage. HIV infection ranked topmost in the list of indications in 2008 and 2009, with a change in trend to previous C/S in subsequent years. Maternal death was significantly lower in women who had C/S (0.1%) compared to those who delivered vaginally (0.4%), p = 0.000. Perinatal death rate was also lower in those who had C/S (4.8%) compared to women delivered vaginally (8.5%), p = 0.000.

Conclusion: Decision to perform primary C/S should be based on clear cut indications as repeat C/S was found to be a major contributor to rising C/S rate in this study. There is thus a need to conduct regular audits on C/S performed in every health institution using the World Health Organization Robson classification and review policies regarding delivery based on the findings.