Caesarean delivery in the Limbé and the Buea regional hospitals, Cameroon: frequency, indications and outcomes

Abstract

IntroductionNeonatal outcomes can be directly and indirectly affected by caesarean delivery (CD). Data on CD rates in semi-urban and rural hospitals in resource-limited settings are scarce and yet are needed to better guide the care of women and neonates in these settings. we carried out this study to determine the frequency of CD, its indications and the frequency of the various adverse neonatal outcomes (ANO) in the Limbe Regional Hospital (LRH) and the Buea Regional Hospital (BRH), Cameroon. We also assessed the relationship between the indication for CD and ANO in the said hospitals.MethodsThis was a hospital-based retrospective and prospective cross-sectional study using descriptive and analytic methods conducted in the LRH and the BRH maternity units within a nine months period in 2015. Informed consent was obtainedfrom mothers of the neonates. Data analyses were performed using Epi-Info 3.5.4 software.ResultsWe recruited 199 neonates born through CD. The prevalence of CD was 13.3% with cephalopelvic disproportion (CPD) being the most frequent (32.2%) indication for CD. There were 52 (26.1%) ANO following CD and respiratory distress was the most common 24 (46.2%) of all ANO. Emergency indications for CD were associated with more ANO 49 (34.5%) as compared to elective indications for CD 3 (5.3%) [p-value<0.001]. We noted a significant association between indications for CD and the various type of ANO, with CPD having the worse prognostic neonatal outcomes 30.8% [p-value=0.02].ConclusionThe prevalence of ANO associated with CD in our hospitals was high with a worrying prognosis. While the exact reasons are unknown, the creation of well-equipped neonatal units with trained staff, may contribute to reduce neonatal morbidity and fatalities. Furthermore, the association of CPD to worse prognostic neonatal outcomes calls for clinicians, to consider additional management options, such as antibiotic prophylaxis and oxygen therapy to the neonates, prior to CD.

Caesarean Section in African Setting: Current Situation, Problematic and Qualitative Approaches at Laquintinie Hospital (Douala, Cameroon)

“…The presence Open Journal of Obstetrics and Gynecology of the fresh uterine scar as a second indication (16.4%) attests to the caution of the obstetricians in our study given the high risk of uterine rupture in this indication and motivated by the absence of a tocograph in our department. This is also the second indication reported by Tonyi et al in Limbé and Buea in Cameroon [22]. The absence of a suitable technical platform for the definite diagnosis of AFD with the measurement of scalp pH forces obstetricians to make this diagnosis solely on the basis of variation of the foetal heartbeat and/or the abnormal colour of the amniotic fluid, justifying the presence of the AFD as 3rd indication of caesarean section in our study.…”

Prevalence, indications and neonatal complications of caesarean deliveries in Cameroon: a systematic review and meta-analysis

“…Three of the studies could be broken up into two separate cohorts of women each [3,21,22], while one of the studies (the Demographic Health survey analysis) was broken up into four cohorts of women [23]. The other studies each reported on a single cohort of women [22,[24][25][26][27][28][29][30][31][32][33][34][35]. In total, 22 cohorts of women were included in the review.…”

“…Two of the cohorts were from the North west region [24,31], two were from the Littoral region [21,33], eight from the Centre region [21,[25][26][27][28][29][30]32], three from the South west region [3,34], three from the Far north region [22,35] and the Demographic Health survey analysis did not specify regions [23]. All the studies used a cross-sectional design except Ngowa et al and Foumane et al [29,30] which utilised a cohort design and Tebeu et al [35] used an additional case-control design to assess the complications of caesarean deliveries.…”

“…Four of the cohorts described pregnant women in rural areas [22][23][24], six in semi-urban areas [3,22,31,34,35] and twelve in urban areas [21, 23, 25-30, 32, 33]. The studies were also divided into three time periods depending on when participants were recruitedbefore 2000 [23,26]; between 2000 and 2009 [21,22,28,32,35] and from 2010 to 2019 [3, 25, 27, 29-31, 33, 34].…”

“…The studies were also divided into three time periods depending on when participants were recruitedbefore 2000 [23,26]; between 2000 and 2009 [21,22,28,32,35] and from 2010 to 2019 [3, 25, 27, 29-31, 33, 34]. Seven of the cohorts had their deliveries in secondary health facilities [3,22,31,34,35], ten in tertiary hospitals and one in a primary health care facility [24].…”