Caesarean Section Audit at the Niger Delta University Teaching Hospital, Yenagoa, Nigeria

Background: Caesarean section (CS) is one of the most common surgical procedures in obstetrics, and it is indicated when delivery by the vaginal route is considered risky or dangerous to the fetus or the mother. Objectives: The main objective of this study is to audit the pattern, trend and outcome of caesarean section at Niger Delta University Teaching Hospital (NDUTH) over the past 6 years. Specifically, it would determine: the socio-demographic characteristics of the patients, the caesarean section rates, the indications, and the associated obstetrics features such as booking status, and the type of caesarean section. It would also determine the maternal complications, fetal and maternal vital statistics, and the factors associated with poor fetal outcome. Methodology and subjects: A retrospective cross-sectional study of 599 pregnant women delivered by caesarean section at NDUTH. The study was carried out from January 2017 to December 2022, at the department of obstetrics and gynecology. Data was collected at the antenatal clinic, antenatal ward, labour ward, labour ward theatre, and the neonatal care unit. Information retrieved include: bio-data, booking status, indication for caesarean section, gestational age at delivery, and the type of caesarean section (elective or emergency). Others were: duration of hospital stay, and maternal complications. Information retrieved on the fetus were: birth weight, 5 minutes APGAR score (for birth asphyxia), fetal outcome, and the factors associated with poor fetal outcome. Data was fed into SPSS version 25 spread sheet and analyzed. Results: The CS rate during the study period was 31.6%, and 82.6% of the CS were emergencies. The increase in CS rate from 2017 to 2022 was very minimal (2.0%). The perinatal mortality rate for CS was 128.6/1000 births, and the maternal mortality ratio (from CS complications) was 482.3/100,000 live births. The most common indication for CS was cephalopelvic disproportion (34.7%), followed by previous (repeat) CS (30.4%). The maternal complication rate was 19.9%, predominantly postpartum hemorrhage (PPH) 8.5%, and postpartum anemia (7.5%). Being unbooked was strongly associated with maternal morbidity, χ2 = 13.68, p = 0.001, and perinatal mortality, χ2 = 15.50, p = 0.001. A great majority of the still births (76.5%) were from unbooked patients. The 5 most significant factors associated with poor fetal outcome were: unbooked status (p = 0.0001), fetal distress (p = 0.001), prolonged obstructed labour, p = 0.001), low educational status (p = 0.02), CS done as emergency p = 0.03. Conclusion: Our CS rate is quite high, and this is largely attributed to too many emergencies. Though our maternal mortality ratio and perinatal mortality rate are comparable to those from other centers in Nigeria, they are too high going by international standards. There is no justification for our pregnant women to die during childbirth or lose her babies. Advocacy to encourage our women to register for antenatal care, women empowerment, and early referral to hospital would improve our morbidity and mortality indices.