five year review of caesarean section in Nnamdi Azikiwe University Teaching Hospital, Nnewi Anambra State, Nigeria. (1st jan.2002 – 31st dec. 2006).

Abstract

Context: Caesarean section is very central to the practice of safe obstetrics, especially in emergency obstetrics care. Frequent review of trends, indications, methods and complications is necessary to ensure safety.
Objective: To determine the patients’ characteristics, indications, techniques and complications of caesarean section done in Nnamdi Azikiwe
University Teaching Hospital, Nnewi, Nigeria over a five year period.
Subjects and methods: The case files of all patients who had caesarean section in the Hospital between 1st January, 2002 and 31st December, 2006 were retrospectively analysed. Parameters assessed include parity, booking status, nature of surgery, indications for surgery, complications and maternal outcome.
Results: There were 2,847 deliveries within the review period with 535 caesarean sections done, giving an incidence of 18.8%. 76.9% of the patients were booked for antenatal care at the hospital while 23.1% were unbooked and were attended to as emergencies. 72.8% of the operations were emergency sections while 27.2 % were electively done. The main indications for the emergency procedures were poor progress/cephalopelvic disproportion (52.90%), obstructed labour (15.10%) and fetal distress (11.72%) while repeat caesarean sections accounted for the majority (66.7%) of elective cases followed by placenta praevia.(15.3%) 80.1% of the surgeries were done by the senior registrars and the rest,
by the consultants. 71.1 % of cases were done under general anaesthesia and the rest under spinal anaesthesia. Majority (75%) of the surgeries were done through a sub umbilical midline incisions and the rest through a pfannestiel incision.3% of the surgeries were complicated of which haemorrhage (50%) and sepsis (25%) accounted for the majority of cases. Twelve maternal deaths (2.2%) were recorded within the period of review. The causes of death were mainly eclampsia (50%) and haemorrhage (33.3%).

Conclusion: The incidence of caesarean section in our centre over the review period was high. Most of the surgeries were done as emergencies and none was carried out by a junior registrar. The morbidity and mortality rates were low.