Maternal deaths associated with cesarean section in Enugu, Nigeria

Ozumba, Benjamin C.; Anya, S E

doi:10.1016/s0020-7292(01)00501-x

Cited by 20 publications

(19 citation statements)

References 2 publications

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“…The paradox is that a significantly higher number of women died in the group that rejected elective caesarean section than in the group that accepted it. The maternal mortality ratio in one of these centres, University of Nigeria Teaching hospital, is 1406/100 000, 7 and the case‐fatality rate for caesarean section is 1.6% 2 . Although these figures are high, knowledge of these facts were not directly responsible for the fears expressed by the respondents.…”

Section: Discussionmentioning

confidence: 99%

“…The major reason given by women for refusing caesarean section was fear of death during surgery. This fear is understandable, given the high rate of maternal deaths associated with caesarean section in sub‐Saharan Africa 2 . The paradox is that a significantly higher number of women died in the group that rejected elective caesarean section than in the group that accepted it.…”

Section: Discussionmentioning

confidence: 99%

“…The actual population of women who rejected caesarean section in real‐life clinical practice has not been previously studied in an African setting. While the contribution of caesarean section to maternal mortality has been reported, 2 no report exists on the consequences of refusing caesarean section in a setting with limited health facilities. Knowledge of the reasons for refusing caesarean section and the resultant delivery outcome are important to show the consequences of such decisions and to provide a basis for developing appropriate strategies to improve the acceptance of caesarean section.…”

Section: Introductionmentioning

confidence: 99%

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The burden of caesarean section refusal in a developing country setting

Chigbu

Iloabachie

2007

BJOG

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Objective To investigate the prevalence, aetiology and outcomes of caesarean section refusal in pregnant women.Design A prospective controlled study.Setting University of Nigeria Teaching Hospital and Aghaeze Hospital, Enugu, Nigeria.Population A total of 62 Nigerian women who declined elective caesarean section.Method Interviewer-administered questionnaires at the time of caesarean section refusal and postdelivery. The delivery outcomes of the subjects were compared with that of a matched control group of women who accepted caesarean section.Main outcome measures Prevalence, maternal reasons for caesarean section refusal and the resultant maternal and perinatal mortality.Results The prevalence of caesarean section refusal was 11.6% of all caesarean deliveries. Maternal reasons for refusing caesarean section include fear of death, economic reasons, desire to experience vaginal delivery and inadequate counselling. Outcomes were significantly worse among women who refused elective caesarean section than in the controls with a maternal mortality of 15% (versus 2%, P = 0.008) and a perinatal mortality of 34% (versus 5%, P < 0.001).Conclusion There is a high prevalence of caesarean section refusal in south-eastern Nigeria. Women declining caesareans have very poor maternal and perinatal outcomes and need extra support.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The burden of caesarean section refusal in a developing country setting

Chigbu

Iloabachie

2007

BJOG

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“…While this increase has been attributed to the fear of litigation (Macfarlane and Chamberlain, 1993), continuous electronic fetal monitoring (Leveno et al, 1986) and improved safety of caesarean section (Penn and Ghaem-Maghami, 2001) in developed countries, the reasons are less clear for developing countries. In Nigeria, for instance, medical malpractice suits are uncommon and abdominal deliveries are still associated with a high risk of maternal morbidity and mortality (Etuk et al, 2001;Ozumba and Anya, 2002). In spite of the high caesarean section rates noted in many studies in Nigeria (Njokanma et al, 2002;OyeAdeniran et al, 2002), there is a paucity of literature with regard to the explanation for such findings.…”

Section: Introductionmentioning

confidence: 99%

The rise in caesarean birth rate in Sagamu, Nigeria: reflection of changes in obstetric practice

Oladapo

Sotunsa

Sule-Odu

2004

Journal of Obstetrics and Gynaecology

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A retrospective and comparative study of women delivered by caesarean section over two different 3-year periods was conducted at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. The caesarean section rate (CSR) increased from 10.3% in 1989-1991 to 23.1% in 2000-2003. The most frequent indication in both periods was different: prolonged/obstructed labour (20.0%) in 1989-1991 and antepartum haemorrhage (14.9%) in 2000-2003. Malpresentation, antepartum haemorrhage and pre-eclampsia/eclampsia were responsible for 51.7% of the difference in the CSR recorded between both periods. The CSR rose from 13.3% to 25.0% while the instrumental vaginal delivery (IVD) rate decreased significantly by 11.4% among the nulliparous women between the periods. Increase in CSR can be attributed mainly to reduction in IVD rate and alteration in the management of labour complications and induction policy. Strategies to reduce the CSR should cut across all indications and focus on encouraging instrumental vaginal deliveries, especially among nulliparous women.

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“…3,4,5 While a few false diagnoses resulting in unnecessary caesarean delivery may be excused against the background of caesarean section safety and the medicolegally driven defensive obstetric practice in the developed countries, the same cannot be said for developing countries where aversion towards caesarean section is strong and caesarean section is still associated with significant maternal morbidity and mortality. 6,7,8 Thus, it is imperative that in developing settings, the anticipated degree of depression after the birth of a supposedly compromised foetus is weighed against the maternal risk of caesarean delivery particularly when a conservative approach is equally practicable.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Severe Neonatal Compromise Following Caesarean Section for Clinically Diagnosed Foetal Distress

Oladapo¹,

Sotimehin²,

Ayoola-Sotubo³

2010

West African Journal of Medicine

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BACKGROUND:The potential harm to a mother and baby from caesarean delivery for clinically diagnosed foetal distress may not always be justified by the degree of neonatal depression at birth. OBJECTIVE: To assess the accuracy of clinical diagnosis of foetal distress indicating caesarean section and identify antepartum and intrapartum characteristics that may predict severe neonatal compromise at birth. METHODS: A chart analysis of 246 singleton caesarean births primarily indicated by clinically diagnosed foetal distress over a ten-year period at a Nigerian University Hospital. Gestational and intrapartum characteristics were compared for severely compromised neonates (Apgar score 0-3) and those with Apgar score of four-seven at one minute of birth. Multivariate logistic regression analysis was applied to determine independent predictors of severe neonatal compromise. (OR ajusté, 0, RESULTS

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Maternal deaths associated with cesarean section in Enugu, Nigeria

Cited by 20 publications

References 2 publications

The burden of caesarean section refusal in a developing country setting

The burden of caesarean section refusal in a developing country setting

The rise in caesarean birth rate in Sagamu, Nigeria: reflection of changes in obstetric practice

Predictors of Severe Neonatal Compromise Following Caesarean Section for Clinically Diagnosed Foetal Distress

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