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An audit of caesarean section in a tertiary hospital northwest Nigeria
Abstract
Background: There is an increasing trend in the rate of caesarean section worldwide and this has become a major cause of concern to obstetricians. Despite the increasing safety of anesthesia and surgical technique, caesarean delivery accounts for more maternal morbidity and mortality compared to a normal vaginal delivery.
Objective: To determine the rate, major indications, and outcome of caesarean delivery in Aminu Kano Teaching Hospital, Kano.
Methodology: This is a 3 year retrospective descriptive study done at Aminu Kano Teaching Hospital (AKTH), Kano. Records of patients who had caesarean section (CIS) were retrieved from the operation record book in the theatre and the labour ward delivery record book. Patients' case files were retrieved. studied and recorded in a proforma. Data analysis was done using SPSS version 17, and proportions were compared using the Chi square test where applicable with level of significance considered at a P-value of <0.05.
Results: During the sludy period from 1st January 2005 to 1st January, 2011, there were 12.600 deliveries, out of which 1 ,966 were delivered by caesarean section, giving a caesarean section rate of 15.6%. There were 1300(66.1) emergency caesarean section and 666(33.9) elective caesarean section. Of the emergency caesarean 305 (23.5) were due to obstructed labour and cephalopelvic disproportion alone, 335(25.5) due to hypertensive disorders in pregnancies. Also 361 (54.2) of the elective caesarean section were due to multiple previous caesarean section. 1022 (52) of caesarean section were done on nulliparous women. There were more post-op complications associated with emergency caesarean selection than elective c/s, with statistically significant di fference in post-op pyrexia and post-op wound infection P< 0.05. There was also statistically significant difference in neonatal complications such as low birth weight, birth asphyxia, birth trauma and neonatal sepsis between emergency c/s and elective c/s with P<0.05. Five patients died post caesarean section giving a maternal mortalily rate of 254 per 100,000. Majority of the deaths were not directly caused by the procedure, as 4 patients died of complications of eclampsia and only one died of post partum hemorrhage. 80% of the deaths were unbooked patients.
Conclusion: Caesarean section rate though high in this study, but within the acceptable range of 5-15% and hypertensive disease in pregnancy was the commonest indication for C/S. Emergency C/S is associated with increased maternal and perinatal morbidity and mortality than elective Caesarean Section.
Keywords; Caesarean section, prevalence. indication, complications
