Maternal and fetal outcomes following cesarean deliveries: A cross-sectional study in a tertiary health institution in North-Western Nigeria

Abstract

Background: Cesarean section (CS) is employed when vaginal delivery is not feasible or hazardous to the mother and/or her baby. The procedure, however, is not without risk. We determined the maternal and early neonatal outcomes of CS in a Tertiary Hospital in Nigeria. Materials and Methods: This is a 2-year cross-sectional study of all CS deliveries performed at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, North-Western Nigeria, from July 01, 2009, to June 30, 2011. All patients who had CS at any time within the 24 h period were noted and followed up until discharge. The sociodemographic data, types of CS, anesthesia, indications, cadre of a surgeon, and feto-maternal outcomes were documented in a proforma. Statistical analysis was carried out using the EPI INFO 3.5.1 (CDC Atlanta Georgia, USA). Results: There were 4462 deliveries out of which 504 (11.3%) were by CS. The age range of the subjects was between 15 and 50 years, and the mean age was 28.7 (3.05) years. Most of the subjects 75.2% (379/504) were multigravida while the primigravida constituted 3.1% (16/504). CS was performed for emergency reasons in 57.1% (288/504) while elective CS constituted 42.9% (216/504) of cases. The most frequent indication for emergency CS was obstructed labor 25.7% (30/288) and previous CS 39.8% (86/216) for elective CS. There were 514 babies delivered during the study of which 98.1% (504/514) were singletons while 1.9% (10/514) was multiple gestations. The maternal complication rate was 13.3% (67/504), and the main complication was hemorrhage 59.7% (40/67). Complications were more frequent with emergency CS compared to elective surgery (Chi-square test [χ2 ] =6.633, df = 1, P < 0.01) and with junior compared to senior residents (χ2 = 15.9, df = 1, P < 0.001). There was also a significant relationship between the fetal Apgar scores and the type of CS. The low 1 st and 5 th min Apgar scores were more frequent with emergency cases compared to elective CS (χ2 = 30.60, df = 1, P < 0.001; χ2 = 4.62.df = 1, P < 0.003). There were 10 maternal and 60 perinatal deaths. Conclusion: The CS rate in this study was 11.3%. Obstructed labor and previous CS among multigravida were the most frequent indications. Maternal and perinatal complications were more frequent with emergency CS and in the referred cases.