Towards optimizing caesarean section: a five-year review of caesarean sections at a Southern Nigeria hospital

Background: Monitoring caesarean sections at hospital level is essential to reduce unnecessary caesarean sections while still ensuring adequate access to caesarean section. This study was conducted to determine the caesarean section rate and indications for caesarean section at the study centre and provide objective data for institutional interventions towards reducing unnecessary caesarean sections in the centre.Methods: A retrospective descriptive study of patients that had caesarean sections between 1st January 2013 and 31st December 2017 at the Federal Medical Centre, Yenagoa, Nigeria. Data were analyzed using Statistical Package for Social Sciences version 22.Results: There were 5,793 deliveries and 1,654 were by caesarean section. The average caesarean section rate was 28.6%. The leading indications for caesarean section were cephalopelvic disproportion (26.6%), previous cesarean section (18.2%), suspected fetal distress (11.2%), severe preeclampsia/eclampsia (7.9%), obstructed labour (6%), and breech presentation (5.9%).Conclusions: The 28.6% caesarean section rate in this study falls within a widely varied rate across Nigeria at hospital level but is comparable to rates within the south-south geopolitical zone of Nigeria. The leading indications for caesarean section are modifiable, thus there is room for institutional intervention to reduce unnecessary caesarean sections. Collaborative research between institutions is required to assess peculiar regional determinants of caesarean section towards developing suitable interventions to reduce unnecessary caesarean sections regionally.

Abdominal pregnancy misdiagnosed as an intrauterine pregnancy: a cause of failed induction of labour for fetal death

Abdominal pregnancy is a rare form of ectopic pregnancy usually associated with fetal death among other complications, although very rare cases of live births have been reported. There is also a high risk of maternal mortality. A high index of suspicion is required to make a preoperative diagnosis as diagnosis from history, examination and ultrasound is often missed. Misdiagnoses as an intrauterine pregnancy usually occur. This misdiagnosis makes management of patients with an abdominal pregnancy a challenge and may affect treatment outcome. We managed a 35 year old pregnant multipara who was referred to us on account of repeated failed attempts at induction of labour for intrauterine fetal death. Three obstetric ultrasound scans done during the course of patient’s management reported an intrauterine dead fetus. We also failed to achieve uterine evacuation. We resorted to carry out a hysterotomy and following laparotomy, we found an abdominal pregnancy. This finding was unexpected by us, however, we delivered the dead fetus and was able to successfully manage the placenta. Discovering an abdominal pregnancy at surgery carried out for a supposed intrauterine pregnancy is usual for many cases of abdominal pregnancy. Clinicians should be aware of the clinical signs and symptoms that raise a suspicion of abdominal pregnancy as prompt preoperative diagnosis of abdominal pregnancy helps to plan and offer early and appropriate intervention. This reduces the incidence of maternal mortality usually due to massive intra-abdominal haemorrhage arising from delayed diagnosis and poor placenta management.