The rise in caesarean birth rate in Sagamu, Nigeria: reflection of changes in obstetric practice

Abstract

A retrospective and comparative study of women delivered by caesarean section over two different 3-year periods was conducted at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. The caesarean section rate (CSR) increased from 10.3% in 1989-1991 to 23.1% in 2000-2003. The most frequent indication in both periods was different: prolonged/obstructed labour (20.0%) in 1989-1991 and antepartum haemorrhage (14.9%) in 2000-2003. Malpresentation, antepartum haemorrhage and pre-eclampsia/eclampsia were responsible for 51.7% of the difference in the CSR recorded between both periods. The CSR rose from 13.3% to 25.0% while the instrumental vaginal delivery (IVD) rate decreased significantly by 11.4% among the nulliparous women between the periods. Increase in CSR can be attributed mainly to reduction in IVD rate and alteration in the management of labour complications and induction policy. Strategies to reduce the CSR should cut across all indications and focus on encouraging instrumental vaginal deliveries, especially among nulliparous women.

Rising trend and indications of caesarean section at the university of Maiduguri teaching hospital, Nigeria

“…Similar to an earlier study in the same hospital [14] and studies from other parts of Nigeria, [5,11,15] a majority of the caesarean sections in this study (79.4%) were performed as an emergency but surprisingly 78.9% of the patients were booked. It would have been expected that the unbooked population will be higher because it is an unbooked status that was related to higher incidence of emergency caesarean section.…”

“…The caesarean section rate of 11.8% in this study was lower than the 18% reported from Jos northern Nigeria, [11] 23.1% reported from Sagamu southern Nigeria [5] and 24.1% reported from Pakistan, [4] a developing country like Nigeria. The caesarean section rate was within the 15% recommended by the World Health Organization (WHO) for developing countries.…”

“…The caesarean section rate of 36.7% in primigravidae is higher than the 25% reported from Sagamu, Nigeria. [5] This is unacceptably high because of the implications of caesarean section on the future reproductive carrier of these groups of patients, especially in this environment large family size is desired.…”

“…[4] While this increase has been attributed to the fear of litigation, more liberal use of caesarean section for breech presentation, the detection of fetal distress by continuous electronic fetal monitoring, abdominal delivery of growthretarded infant, and improved safety of caesarean section in developed countries; the reasons are less clear in developing countries. [5,6] In Nigeria, for example, in spite of the high incidence of caesarean section and increasing rate noted in many studies, there is paucity of literature with regard to the reason for such findings. [5,7] Some of the reasons being adduced include, the specialist and referral nature of some of the hospitals, unbooked status of most of the patients, increasing use of fetal heart rate abnormalities alone as a measure of diagnosis of fetal distress in labor, overdiagnosis of cephalopelvic disproportion by junior doctors, and use of repeat caesarean section for patients with a previous caesarean section.…”

“…[5,6] In Nigeria, for example, in spite of the high incidence of caesarean section and increasing rate noted in many studies, there is paucity of literature with regard to the reason for such findings. [5,7] Some of the reasons being adduced include, the specialist and referral nature of some of the hospitals, unbooked status of most of the patients, increasing use of fetal heart rate abnormalities alone as a measure of diagnosis of fetal distress in labor, overdiagnosis of cephalopelvic disproportion by junior doctors, and use of repeat caesarean section for patients with a previous caesarean section. [4,8,9] Perinatal mortality rate shows no significant diminution despite the increasing caesarean section rate.…”