Emergency caesarean section and its sequelae in a tertiary hospital in Niger Delta, Nigeria

Background: Caesarean section (CS) is a major obstetric surgery done for pregnant women and is lifesaving. Aim: The study was aimed at reviewing CS at the Rivers State University Teaching Hospital (RSUTH), to determine the prevalence, trend and indications, for improved management outcomes. Methods: In this cross-sectional study, we reviewed five thousand, five hundred and ninety-eight (5598) cases of caesarean sections (3699 emergency, 1899 planned) managed at the RSUTH from 1st January, 2015 to 31st December, 2019. Data collected were analysed using IBM, Statistical Product and Service Solutions (SPSS), version 25.0 Armonk, New York. Results: There were 13,516 deliveries and 5,598 cases of CS over the review period, giving the prevalence of CS as 41.4% or 414 per 1000 deliveries. Emergency and planned CS cases accounted for 66.1% and 33.9% respectively. An increasing trend of CS was observed over the review period. The mean age ± SD of the participants was 32.30±1.04 years (95% CI:30.26,34.34). Modal age group was 35-39 years, accounting for 33.2% followed by those aged 30-34 years (26.2%). Majority of the patients were multipara [3396 (60.7%)], married [4890 (87.4%)], Christians [5540 (99%)] and had tertiary level education [2800 (50%)]. The commonest indication for CS in RSUTH was previous caesarean section [1925(34%)], followed by cephalopelvic disproportion [757(13.4%)], foetal distress [418(7.4%)], preeclampsia [390(6.9%)] and multiple gestation [252 (4.5%)]. Conclusion: The rate of caesarean section is high in RSUTH with an increasing trend. Although CS is lifesaving, efforts should be made to reduce the rate to the level recommended by WHO, especially in Low-middle-income countries (LMICs), where there is high aversion to CS.

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“…Overall, the yearly rates of emergency CS outnumbered planned caesarean sections, in keeping with previous studies [7,20,25].…”

Section: Discussionsupporting

confidence: 89%

A Five-Year Review of Caesarean Section at the Rivers State University Teaching Hospital, South-South, Nigeria

Wekere

Iwo-Amah

Kwosah

et al. 2021

JAMMR

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“…The mean age of women who had cesarean section (CS) was 31.09 SD 4.5(95% CI: 30.6, 31.1) (range 20-43 years). This is similar to findings in other hospital based studies among hospital booked pregnant women [10,11,12] . Highest parity among study group was para 1 (30%)…”

Section: Analysis Of Resultssupporting

confidence: 92%

Need for blood transfusion during cesarean section in rivers state university teaching hospital

Iwo-Amah¹,

Nwogu²,

Nkasiobi³

et al. 2022

Int. J. Clin. Obstet. Gynaecol.

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Background: Cesarean Section (CS) has been associated with major intra operative Blood loss. Obstetric hemorrhage has been identified as a major cause of direct maternal mortality, maternal near miss and Maternal morbidity. Blood transfusion is often associated with CS. With the advent of various medical and surgical techniques to prevent excessive blood loss during CS, the need for blood trans fusion in every CS procedure need to be reviewed. High risk pregnancy cases may require blood transfusion. However, 90% of low risk pregnancy cases may not require blood transfusion, especially when the application of blood loss preventive measures are put in place. Aim: The aim of this study is to ensure thorough review of patients peri-operatively, and to find out if intra-operative measures can reduce the need for blood transfusion during CS. Method: This was a retrospective cross sectional study of 1000 patients who had Cesarean section between January 2020 to December 2021. Five hundred (500) of them were cases associated with high risk factors for massive hemorrhage at CS, and thus with increased need for blood transfusion. The other 500 were low risk cases for intra operative hemorrhage during CS. It was expected that blood transfusion will be minimal within this group. The result was that these blood loss preventive measures helped to reduce intra-operative blood loss, thus reduced the need for blood transfusion. In addition, the modal units of blood transfused was 2units, unlike previous studies where modal Transfusion was 3 units [1,3,4] . Two hundred and three (203) 40.6% were transfused in the high risk group. Only 11(2.2%) were transfused in the low risk group. Conclusion:The need for blood transfusion during cesarean section was reduced with adequate perioperative preparations. Optimizing maternal hemoglobin concentration during the antenatal period may reduce the incidence of cesarean section related blood transfusion.

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“…Undiagnosed TTTS also posed delivery challenges once unrecognized severe growth discrepancy and malpresentation came to light. Accessing emergency cesarean capabilities in such a remote setting averted likely adverse outcomes for the second twin but this may not be feasible for all patients (11).…”

Section: Discussionmentioning

confidence: 99%

Fishing in Murky Waters: The Challenging Route to Diagnosing Twin-Twin Transfusion Syndrome in a Resource-Limited Humanitarian Setting, A Case Study

Okot,

Ochola,

Aeku

et al. 2024

Preprint

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Background Twin-to-twin transfusion syndrome (TTTS), though rare, poses risks for fetal demise if undetected. This late-diagnosed TTTS case from South Sudan demonstrates persistent challenges in identifying high-risk pregnancies in humanitarian settings. Case presentation: A 38-year-old multigravida at unknown weeks gestation presented with fever, labour pains, drainage of liquor, and fetal hand prolapse. Her antenatal care only reported non-specific symptoms without most diagnostics. Evaluation revealed malaria, suspected twin pregnancy, and malpresentation. Ultrasound confirmed polyhydramnios and a suspicious intrauterine mass concerning for TTTS. Undiagnosed TTTS became apparent only during emergent cesarean delivery, finding a demised anomalous donor twin. The acute intrapartum decompensation pointed to late-stage V TTTS preventing intervention. While the viable preterm neonate survived, risks from demise were avoidable through earlier detection. Conclusion This case reinforces literature on missed screening opportunities to recognize TTTS before Quintero staging with poorer prognoses. Subtle signs like sudden abdominal enlargement during third trimester were likely overlooked due to limited access to comprehensive ultrasound and Doppler surveillance. Strengthening displacement-sensitive antenatal protocols, building frontline imaging capacity, improving provider awareness, and prompt referrals could help mitigate TTTS-related morbidity and mortality in marginalized populations. Global health efforts must address these persisting care gaps in pregnancy surveillance and access to specialty care, especially in humanitarian settings.

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Emergency caesarean section and its sequelae in a tertiary hospital in Niger Delta, Nigeria

Cited by 6 publications

References 0 publications

A Five-Year Review of Caesarean Section at the Rivers State University Teaching Hospital, South-South, Nigeria

A Five-Year Review of Caesarean Section at the Rivers State University Teaching Hospital, South-South, Nigeria

Need for blood transfusion during cesarean section in rivers state university teaching hospital

Fishing in Murky Waters: The Challenging Route to Diagnosing Twin-Twin Transfusion Syndrome in a Resource-Limited Humanitarian Setting, A Case Study

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