Analysis of caesarean delivery in Jimma Hospital, south-western Ethiopia

In this prospective study, 100 mothers who have undergone caesarean section in Jimma Hospital from 23rd June 1992 to 24th September 1993 were analysed to determine the incidence, indications and post operative complications of caesarean delivery. During the study period, there were 1236 deliveries, of whom 100 mothers were delivered by caesarean section; giving a caesarean birth rate of 8%. The leading indications for caesarean section were cephalopelvic disproportion (44%), malpresentations and malpositions (21%), repeat caesarean section (16%), antepartum haemorrhage (8%) and foetal distress (6%), accounting for 95% of the indications for caesarean section. There was no maternal death, but the overall morbidity rate was 20%. The causes of morbidity were wound infection (27.1%), sepsis (21.4%), endometritis (33.3%), haemorrhage (8%) and wound dehiscence (10%). The gross perinatal mortality rate of 120 per 1000 live births was not significantly higher than the rate for all deliveries, which was 92.5% per 1000 live births (P < 0.5). The single most important cause of perinatal death was prolonged and obstructed labour. In order to reduce the high perinatal mortality and maternal morbidity, there is a strong and urgent need to prevent prolonged and obstructed labour through effective antenatal care and referral system.

Caesarean section and foetal outcome at Yekatit 12 Hospital, Addis Abeba, Ethiopia, 1987-1992

This retrospective study was carried out to examine indications for Caesarean section (CS), foetal outcome and postoperative complications and to recommend ways of reducing maternal and neonatal deaths. In a five year period (September 1987 to August 1992), among 11,657 consecutive deliveries at Yekatit 12 Hospital, Addis Abeba, Ethiopia, there were 645 CSs, an overall CS rate of 5.5%. During this study, the indications for CS were cephalopelvic disproportion (31.2%), foetal distress (21.4%), previous CS (17.5%), placenta praevia (6.6%), cord prolapse (4.2%) and others (19.1%). There were 99 perinatal deaths, a gross perinatal mortality rate of 153.5 per 1,000 live births, which was a significantly higher rate than the total rate for all deliveries (67.5 per 1,000 live births, p < 0.01). There were seven maternal deaths (case fatality rate of 1.1%). The very high perinatal mortality in this study calls for a better and more effective antenatal service to improve foetal and maternal survival. This could be achieved by strengthening the referral system for pregnant women with obstructed and prolonged labour.

Safe motherhood: cesarean section or symphysiotomy?

The place of symphysiotomy in the management of cephalopelvic disproportion is discussed on the basis of the existing literature, reviewing maternal mortality and morbidity after symphysiotomy and the vaginal delivery rate in a subsequent pregnancy after a previous symphysiotomy. These are compared with the outcome of cesarean section performed in similar circumstances.

Neonatal outcome following cesarean birth: a prospective study

Neonatal morbidity and mortality in 573 singleton cesarean born infants was recorded. In 70% of women, it was a primary cesarean section. The neonatal mortality was 3.6% in babies born to primigravida mothers and 9.8% in infants of multigravida. Mortality in male and female infants was 5.73 and 9.65%, respectively. Preterm infants registered more than 7 times higher mortality than term infants. Birth weight below 2000 g and above 3500 g were associated with higher asphyxia rate and neonatal death. Neonatal morbidity frequently encountered was birth asphyxia (19.19%), septicemia (13.43%), jaundice (15.70%) and respiratory problems (23.0%).

Mortality and immediate morbidity in term babies with low Apgar scores (Zimbabwe)

A retrospective study was undertaken to document immediate morbidity and mortality associated with low Apgar scores (5 or less) at 5 min in singleton term babies (37 weeks or more). From October 1986 to February 1987, 84 term babies had low Apgar scores, giving an incidence of 15/1000 live births. Overall mortality in these patients was 42%, and in those in whom Apgar scores remained 0-3 at 5 min, mortality was 77%. Evidence of severe-to-moderate hypoxic-ischaemic encephalopathy was noted in 44 (52%) and 17 (20%) failed to establish spontaneous respiration within the 1st few hours of life. Meconium aspiration syndrome was diagnosed in 29 (35%). A control group of 141 term babies with 5-min Apgar scores of 7 or more were identified and the presence of possible risk factors associated with low Apgar scores was assessed. Primiparity and prolonged second stages of labour in all parities were found to be significantly associated with low Apgar scores. Improved obstetric care and appropriate management of the newborn at delivery and in the neonatal period may help to reduce mortality and morbidity in some term babies.

Multiple pregnancy as a risk factor in rural Tanzania

The prevalence of twin pregnancies in two rural hospitals in the South Western Highlands of Tanzania ranged from 15 to 20 per 1,000 births. The literature on the generally assumed high twinning rates in the whole of Africa is reviewed. High prevalence figures can be the result of hospital selection, as most African studies are hospital-based. Only from Nigeria, one population-based study revealed a rate of 45 per 1,000. In both hospitals perinatal mortality in twin births was strikingly low, especially when birthweight was at least 1,500 g: between 30 and 40 per 1,000 births. It is argued that there is no place for a more liberal use of caesarean section to further reduce perinatal mortality.