A Five-Year Review of Caesarean Section at the Rivers State University Teaching Hospital, South-South, Nigeria

Abstract

Background: Caesarean section (CS) is a major obstetric surgery done for pregnant women and is lifesaving. 
 Aim: The study was aimed at reviewing CS at the Rivers State University Teaching Hospital (RSUTH), to determine the prevalence, trend and indications, for improved management outcomes.
 Methods: In this cross-sectional study, we reviewed five thousand, five hundred and ninety-eight (5598) cases of caesarean sections (3699 emergency, 1899 planned) managed at the RSUTH from 1st January, 2015 to 31st December, 2019. Data collected were analysed using IBM, Statistical Product and Service Solutions (SPSS), version 25.0 Armonk, New York.
 Results: There were 13,516 deliveries and 5,598 cases of CS over the review period, giving the prevalence of CS as 41.4% or 414 per 1000 deliveries. Emergency and planned CS cases accounted for 66.1% and 33.9% respectively. An increasing trend of CS was observed over the review period. The mean age ± SD of the participants was 32.30±1.04 years (95% CI:30.26,34.34). Modal age group was 35-39 years, accounting for 33.2% followed by those aged 30-34 years (26.2%). Majority of the patients were multipara [3396 (60.7%)], married [4890 (87.4%)], Christians [5540 (99%)] and had tertiary level education [2800 (50%)]. The commonest indication for CS in RSUTH was previous caesarean section [1925(34%)], followed by cephalopelvic disproportion [757(13.4%)], foetal distress [418(7.4%)], preeclampsia [390(6.9%)] and multiple gestation [252 (4.5%)].
 Conclusion: The rate of caesarean section is high in RSUTH with an increasing trend. Although CS is lifesaving, efforts should be made to reduce the rate to the level recommended by WHO, especially in Low-middle-income countries (LMICs), where there is high aversion to CS.

Prevalence, indications, and complications of caesarean section in health facilities across Nigeria: a systematic review and meta-analysis

“…Based on facility-type, tertiary facilities were the most dominant study settings (80.0%) among the included studies in our review. However, we found the reported prevalence rates in tertiary facilities (5.5–56.5%) to be broadly comparable with the prevalence rates in secondary facilities (5.4–37.7%), with only nine [ 23 , 25 , 39 , 46 , 49 , 52 , 53 ] of the 70 tertiary facilities included in the review recording intra-facility CS rates greater than the range observed in secondary facilities. A similar pattern of comparable intra-facility CS prevalence in secondary (10.1% (95% CI: 5.1, 16.6%)) and tertiary hospitals (15.4% (95% CI: 12.5, 18.6%)) was reported in a Cameroonian systematic review [ 75 ].…”

“…Also, 82.2% of the included studies were conducted in public [ 21 – 38 , 40 , 42 , 44 – 55 , 57 , 58 , 60 – 62 , 64 , 65 ] and 80.0% were conducted in tertiary [ 21 – 40 , 42 , 44 – 47 , 49 – 55 , 57 , 58 , 60 – 62 , 65 ] facilities. Also, 32 (71.1%) studies [ 21 – 44 , 58 – 64 ] were conducted between 2000 and 2014 (pre-WHO CS statement), while eight (17.8%) studies [ 45 – 52 ] were conducted after the WHO statement was published (i.e., from 2015). The remaining five (11.1%) studies [ 53 – 57 ] had their study periods overlapping both timeframes (Table 1 ).…”

“…The raw proportions (W = 0.94 p -value < 0.01) deviated less further from a normal distribution after logit transformation (W = 0.96, p -value = 0.03). The prevalence of elective and emergency CS in facilities was reported from 33 studies [ 21 , 22 , 24 – 30 , 32 – 42 , 44 , 45 , 48 , 50 , 52 , 55 – 60 , 62 , 65 ].…”