Abstract

Background: Cesarean Section (CS) rates and their indications vary all over the World. Audit of indications and factors affecting infant and maternal outcome remain an important activity in rationalizing the use of this major procedure in obstetrics practice. Cesarean section (CS) carries a higher maternal morbidity and mortality compared to vaginal delivery. Noresearches have been done on this area.

Objective: To determine the leading indications for ECS and their associated maternal and neonatal outcomes in St. Paul’s Hospital Millennium Medical College(SPHMMC).

Methodology: Retrospective facility-based study was used, and data was collected by reviewing the log book of patients who underwent CS operations at St.Paul’s Hospital Millennium Medical College (SPHMMC) gyneocology obstetric department from 1st February to 30th May 2017. The leading indications for Emergency Cesarean Section (ECS) were determined in terms of frequency and percentage. Clinical outcomes of the mothers and the delivered newborns were gauged by morbidity, mortality and survival rates (i.e. within the hospital confinement).

Result: A total of 2345, deliveries were conducted, of which 582 deliveries were by cesarean section procedures making the institutional cesarean section rate of 24.8%. Records of patients who underwent Emergency Cesarean section (ECS) were retrieved and comprised the study population (N=522). Perinatal Asphyxia (PNA) was the most common cause of the neonatal death 6 (42.9%). Dystocia (26.4%) emerged as the leading indication for ECS followed by non-reassurance fetal heart rate pattern (NRFHRP) (18.8%). An association between indications of EC/S,Appearance, Pulse, Grimace, Activity, Respiration(APGAR) scores at 5th minute and fetal outcome with p value of < 0.05 was observed.

Conclusion: The institutional cesarean section rate is 25%, maternal outcome was favorable with 94.8% of smooth post operation course and surgical site wound infection was 63.0% among post operationcomplications that mothers developed.Dystocia (26.4%) emerged for ECS followed by non-reassurance fetal heart rate pattern (NRFHRP) (18.8%),Meconium stainedAmniotic fluid (10.7%)and failed induction(5.4%). Neonatal outcome with survival rate of 94.1%.There was an association between indications of emergency caesarean section(ECS), Appearance, Pulse, Grimace, Activity, Respiration(APGAR) scores at 5th minute and fetal outcome with p value of < 0.05. [Ayano B, Guto A Assessment of indications for emergency cesarean section and its outcomes at St. Paul’s Hospital Medical College, Addis Ababa, Ethiopia 2017: (afour-month retrospective cohort study.)]

Keywords: Caesarean section; Pregnancy outcome; Operative delivery; Ethiopia

Abbreviations: AOG: Age of Gestation; ANC: Antenatal Care; APGAR: Appearance Pulse Grimace Activity Respiration; C/S: Caesarean Section; ECS: Emergency Caesarean Section; EONS: Early Onset Neonatal Sepsis; GC: Gregorian Calendar; GYN-OB dep’t: Gyneocology Obstetric Department; IUGR: Intrauterine Growth Restriction; MAS: Meconium Aspiration Syndrome; MSAF: Meconium Stained Amniotic Fluid; NICU: Neonatal Intensive Care Unit; NPH: Non Physician Clinician; NRBPP: Non Reassurance Biophysical Profile; NRFHRP: Non Reassurance Fetal Heart Rate Pattern; PIH: Pregnancy Induced Hypertension; PNA: Perinatal Asphyxia; POP: Post Operation; SPHMMC: St Paul’s Hospital Millennium Medical College; THAT: Tikuranbessa Teaching Hospital