Markers and the Materno-Foetal Result of Caesarean Section: A Study at the Secondary Health Facility in Obudu, Cross River State, Nigeria | Chapter 1 | Medical Science: Recent Advances and Applications Vol. 3

Background: Caesarean section (CS) refers to the delivery of a foetus, placenta and membranes after the age of viability through an abdominal and uterine incision. Caesarean section is further divided into two subtypes as far as the urgency of the operation is concerned. Elective caesarean section refers to those occasions where the decision to carry out caesarean section is made and planned more than 24 hours before delivery. Caesarean section (CS) is an important tool in obstetric care for the reduction of maternal and foetal morbidities and mortalities. This study was done to determine the CS rate, the indications and the maternal and foetal outcome of emergency and elective caesarean sections at the Sacred Heart Hospital Obudu, Cross River State.

Methods: A retrospective review of clinical records of all patients delivered by CS from September 2011 to August 2016 at the Sacred Heart Hospital, Obudu, Cross River State, Nigeria was conducted. Data for the study were extracted from theatre records, labour ward records and neonatal ward records using a structured questionnaire. The information obtained included socio-demographic variables, obstetric history and outcome of caesarean section. The data collected was checked for its completeness, entered into a computer and analysed using SPSS version 20.0. Frequencies.

Results: There were 2445 deliveries with 453 caesarean sections during the review period, giving a CS rate of 18.1%. Emergency CS accounted for 338(74.6%), while elective CS accounted for 115(25.6%). The main indications for emergency CS were cephalo-pelvic disproportion (CPD) (16.9%) and obstructed labour (16.0%), followed by breech deliveries. Previous CS was the main indication for elective CS (50.4%). Generally, the maternal and foetal outcomes of elective CS were better than emergency CS. There were 4 deaths, all accounted for by emergency CS, giving a CS mortality of 0.9%. Maternal morbidities like post-partum haemorrhage, sepsis, and prolonged hospital stay were worse among the emergency CS patients. Some conditions, like obstetric fistula and ruptured uterus, were found only amongst the emergency CS patients. For foetal outcome, poor Apgar score, sepsis, death, jaundice and need for referral were worse among emergency CS patients.

Conclusion: The incidence of CS is high in this centre, with a higher rate of emergency than elective CS. Also, the maternal and foetal outcomes of emergency CS were worse than those of elective CS. Caesarean section remains an important tool in obstetrics practice for the reduction of maternal and neonatal morbidity and mortality. In this review, the main indications for emergency CS were CPD, obstructed labour and breech presentation, while previous CS was the main indication for elective CS.

 

Author (s) Details

Maanongun MT
Department of Obstetrics and Gynaecology, College of Health Sciences, Benue State University, Makurdi, Benue State, Nigeria.

 

Ornguze AA
Department of Obstetrics and Gynaecology, College of Health Sciences, Benue State University, Makurdi, Benue State, Nigeria.

 

Ojabo AO
Department of Obstetrics and Gynaecology, College of Health Sciences, Benue State University, Makurdi, Benue State, Nigeria.

 

Eka PO
Department of Obstetrics and Gynaecology, College of Health Sciences, Benue State University, Makurdi, Benue State, Nigeria.

 

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v3/2630

Changing Trends in Indication of Cesarean Section: A Case Study of a Tertiary Care Centre of Central India | Chapter 13 | Advancement and New Understanding in Medical Science Vol. 9

Background: Cesarean section is the most common major surgical procedure performed in obstetrics. There is increase in the rate of Cesarean section in both developed and developing countries. This study was carried out to find the rate of Cesarean section (CS) in our institute from 2012 to 2016 and also to find any change in the indications of CS over these five years.

Methods: A retrospective analysis of data was done from the records of the patients who underwent CS and the rate of Cesarean section and the indications were noticed. Year-wise data of cesarean section and vaginal deliveries was recorded and the rate of cesarean section in each year was calculated. Data was collected from labour register and operation register and the results were summarized in percentages and proportions.

Results: The rate of Cesarean section has increased from 43.85% in 2012 to 48.18% in 2016. There is increase in the number of Primary Cesarean cases from 61.8% in 2012 to 68.4% in 2016.The percentage of Elective CS has increased in last five years from 10.2% in 2012 to 23.6% in 2016 which is due to the drastic increase in Elective Repeat CS from 13.3% in 2012 to 43.4% in 2016. The first and second major indication of Primary CS over the years remained the same i.e. fetal distress and CPD. Other major contributing indications were Non-progress of labour, failed induction and Malpresentation. Oligohydraminos and IUGR, Multiple pregnancy and precious pregnancy have emerged as the major indication in last three years. Previous CS and Previous 2 CS contributed as the main indication for Elective CS. The CS rate in 2015-16 was 50.5% which is high due to increase number of cases referred from periphery.

Conclusions: There is increase in the rate of Cesarean section not only in India but globally also. However, the rate of Cesarean section need to be reduced. The overall main indication for CS was Previous CS and thus Primary CS rate should be reduced. Fetal distress being the main indication for Primary CS should be further confirmed by fetal scalp pH findings and Repeat CS cases should be given more trial of labour.

Author(s) Details:

Pooja Patil,
Department of Obstetrics and Gynecology, L. N. Medical College, Bhopal, Madhya Pradesh, India.

Malini Bhardwaj,
Department of Obstetrics and Gynecology, L. N. Medical College, Bhopal, Madhya Pradesh, India.

Priyanka Sharma,
Department of Obstetrics and Gynecology, Sita Devi Hospital, Jaipur, Rajasthan, India.

Garima Chandrakar,
Department of Obstetrics and Gynecology, L. N. Medical College, Bhopal, Madhya Pradesh, India.

Please see the link here: https://stm.bookpi.org/ANUMS-V9/article/view/13638