Determinants and outcomes of elective and emergency caesarean section at a tertiary hospital in Abakaliki, Southeast Nigeria: A 6-year review

Background: Despite its increasing acceptance as a safe alternative to vaginal delivery, caesarean section (CS) in developing countries continue to be associated with maternal and fetal morbidity and mortality. Objectives: This study was aimed at evaluating the indications, outcomes and factors associated with increased CS at the Federal Teaching Hospital, Abakaliki. Methods: This was a six year retrospective study covering 2012 to 2017. Case notes of patients were identified and retrieved from the records unit of the hospital. Information extracted include sociodemographic variables, indications and types of CS performed and the complications. These data were entered into a personal computer and analysed with Epi Info version 7. Results: These were presented using tables and percentages. A p-value of 0.05 was considered significant. In 6 years, 11,215 women were delivered, 2405 (21.4%) had emergency CS while 1445 (12.9%) had elective CS; giving a CS rate of 34.3%. The most common indication for emergency CS was cephalopelvic disproportion (22.0%) while previous caesarean section (27.7%) formed the major indication for elective CS. Severe birth asphyxia was recorded in 17.2% and 4.2% of babies delivered by emergency and elective CS respectively. Booking status, parity and patient's age had statistically significant association with the chance of having a CS. Maternal and perinatal deaths were recorded in 2.6% and 5.0% for emergency CS compared to 1.0% and 0.2% for elective CS. Although lifesaving, CS, due to an existing condition or complication in the patient, may be associated with an increase in maternal and fetal morbidities and mortalities. Conclusion: There was a higher burden of complication with emergency CS due to its associated determinants. Adequate training of healthcare personnel on ways of minimizing complications against the backdrop of an existing problem and an efficient referral system will help reduce these morbidities and mortalities.