Primary Caesarean Deliveries in a Private Hospital in Lagos

Context: Primary caesarean section increases the chances of subsequent operative delivery with its attendant problems. It is necessary to frequently review the indications for primary section in order to reduce rates. Objective: To examine the indications for primary caesarean section. Study Design, Setting and Subjects: A descriptive, fifteen-year report (1983 through 1997) of primary caesarean section from a private hospital in Lagos, Nigeria. Main Outcome Measures: Primary caesarean section rates in nulliparae and multiparae. Results: The overall primary caesarean section rate was 19.6%. It was higher for nulliparae than for previously parous women (32.0% Vs 11.5%, p < 0.0001) with cephalopelvic disproportion and poor progress in labour accounting for 72.2% of the difference in rates. About 90% and 80% of sections in nulliparae and multiparae respectively, were emergencies; cephalopelvic disproportion and poorly progressing labour accounted for twothirds and one-half of each subgroup respectively. Fetal malpresentation was the dominant indication for elective surgery in nulliparae (59.6%) and multiparae (32.6%). The incidence rates of cephalopelvic disproportion, failure to progress in labour, severe hypertension and fetal distress were all higher in nulliparae than in multiparae. but it was the reverse with antepartum haemorrhage Conclusions and Recommendations: Primary caesarean section is commoner in nulliparae than multiparae probably because previous successful vaginal delivery encourages more patient trial of labour in the latter group. A critical, individualised evaluation of cases of poor progress in labour is advocated to effect a decline in the incidence of this indication for surgery. Key Words: Primary Caesarean Section, Cephalopelvic Disproportion, Malpresentation. [Trop J Obstet Gynaecol, 2004; 21:156-159]