Abstract
Objectives: The aim of this study was to analyse key factors and main indications of primary caesarean sections and find out ways to reduce the rising rates. Patients and method: This was a longitudinal and retrospective study carried out from 1 January 2012 to 31 December 2016. The study included all patients in whom a primary CS was performed. A previous uterine scar was a non-inclusion criterion. We analysed the main indications and their trends during these five years, Apgar score at the 5th minute according to the course of caesarean section rate and the impact of daily audit. Data were collected retrospectively from 2012 to 2015, then prospectively in 2016 using a Filemaker database. Data were analysed with SPSS 21 software, Mac version. Averages were calculated for quantitative data and percentage for qualitative ones. The statistical tests used were the Pearson Chi2 test. The differences observed were considered significant when the p value was less than 0.05. Results: During the study period, we registered 21.308 deliveries and 6.292 caesarean sections (29.5%). Primary CS concerned 72.5% of overall CS. The main indications were suspicious of fetal distress (29.1%), obstructed or prolonged labour (21.7%), breech and twin delivery with respectively 8.2% and 5.2%. We registered more vaginal deliveries with induction of labour: 81.4% versus 75.2%. An obstetrical audit allowed better management of labour and decrease of CS rate. Conclusion: We need to focus on diagnosis of fetal distress, management of breech presentation in twin delivery and singleton. The induction of labour can be an effective alternative in some indications. An obstetrical audit is necessary to reverse caesarean section rate.
Highlights
Caesarean section (CS) is a surgical procedure used commonly to reduce maternal and neonatal morbidity
We analysed the main indications and their trends during these five years, Apgar score at the 5th minute according to the course of caesarean section rate and the impact of daily audit
Women with unscarred uterus represented 18.933 and a primary CS was performed on 4.564 which is equal to 72.5% of overall CS
Summary
Caesarean section (CS) is a surgical procedure used commonly to reduce maternal and neonatal morbidity. CS rate without medical indications can expose mothers and newborns to unnecessary risks [1]. According to the World Health Organization (WHO), an appropriate CS rate should be between 5 and 15% [2]. CS rate is increasing steadily in many countries [2]. In Senegal, a Sub-Saharan low-income country, the national CS rate in 2014 was 4.4% with huge disparities between facilities: from 0.1% in remote areas to 50.2% in the capital [5]. According to Robson’s Ten Group classification system, one of the steps of maintaining an appropriate CS rate is an assessment of obstetrical management [6]. Many studies showed the major contribution of Group 5 (previous caesarean section, singleton, cephalic, after 37 weeks’ gestation) in the increase of CS rate [4] [7] [8]
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