Determinants of perinatal outcome in preterm caesarean section in University of Nigeria Teaching Hospital.

Abstract

Background: Preterm Caesarean section may most probably, add further pressure to the already existing poorly developed facilities for intensive perinatal care in low resource countries.

Aim: The aim of this study is to determine the perinatal outcome following preterm Caesarean section in a low resource centre, to comparing the perinatal outcome of term and preterm Caesarean sections and identify predictors of adverse perinatal outcome in preterm Caesarean section.

Method: A retrospective case controlled study to examine the pattern, outcome and predictors of adverse perinatal outcome in preterm caesarean section. A control of two term to one preterm Caesarean section was selected and their outcome compared. Chisquare test and Odds ratio were used for statistical analysis. P-values of 0.05 or less were considered significant.

Result: Of the 3037 deliveries 733 (24.1%) were caesarean sections and 109 (14.9%) of these were preterm Caesarean sections. Maternal medical diseases (28.4%) and poor progress of labor (19.0%) were the commonest indication for preterm caesarean sections. Perinatal
mortality was 178/1000 births in preterm Caesarean sections compared to 74/1000 births in the control (p = 0.004; odds ratio 2.7, 95% confidence interval (CI) 1.3-5.8). Birth asphyxia was the commonest cause of perinatal mortality in both groups. Low Apgar score (< 7) was
commoner in the preterm group than control (P < 0.001; odds ratio 2.8, CI 1.6-4.8).

Conclusion: Preterm Cesarean section constitutes a significant burden in perinatal care. The most important predictor for poor perinatal outcome on multivariate analysis was gestational age. In most indications of preterm Caesarean sections in this study operative deliveries could not be averted easily however planned surgery significantly improved
perinatal outcome.