Tropical Journal of Obstetrics and Gynaecology

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Feasibility of Reducing the Caesarean Section Rate at the University of Nigeria Teaching Hospital, Enugu, Nigeria

Peter O. Nkwo, Hyacinth E. Onah


Context: Caesarean section carries a significantly higher mortality and morbidity than vaginal delivery. There has been a growing concern over the increasing rate of caesarean operations worldwide and the need to reduce this. This is particularly important in Nigeria where women dislike the operation and the risks are significantly increased due to fragile health facilities.

Objective: To evaluate the feasibility of reducing the caesarean section rate in a Nigerian tertiary obstetric centre.

Study Design, Setting and Subjects: A critical analysis of caesarean sections performed at the University of Nigeria Teaching Hospital, Enugu, Nigeria from 1st January 2000 to 30th June 2002.

Results: There were a total of 906 caesarean sections (CS) out of 3626 deliveries giving an overall caesarean section rate (CSR) of 25.0%. Seven out of the 27 indications for the operation accounted for 91% of the cases. These were: 2 or more previous caesarean sections (22.0%), dystocia/cephalopelvic disproportion (20.6%), 1 previous caesarean section (17.4%), hypertensive disorders (9.4%), antepartum haemorrhage (8.3%), fetal distress (7.3%) and breech presentation (6.1%). In the assessment of the authors, the hospital CSR of 25% can be reduced by nearly 25% if some basic facilities are provided in the hospital, if the decision-intervention interval is minimised in emergency situations and if the physicians change their practice styles

Conclusion: It is feasible to reduce the caesarean section rate in Nigerian tertiary care practice if hospital administrators provide the necessary monitoring tools and minimise institutional delays, and if physicians stop practising along planes of least resistance.

Key Words: Caesarean Section, Delivery, Rate, Obstetric Practice.

[Trop J Obstet Gynaecol, 2002, 19: 86-89]

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