TITLE:
How to Avoid Primary Caesarean Section? A Five-Year Experience Report from a Level 2 Facility in Dakar Senegal
AUTHORS:
Mame Diarra Ndiaye Gueye, Mamour Gueye, Magatte Mbaye, Abdelouahed Chraibi, Aliou Diouf, Mouhamadou Wade, Moussa Diallo, Omar Gassama, Mor Cisse, Youssoupha Toure, Moustapha Thiam, Jean Charles Moreau
KEYWORDS:
Caesarean Section Rate, Indications, Apgar Score, Obstetrical Audit
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.7 No.12,
November
15,
2017
ABSTRACT: Objectives: The aim of this study was to analyse key factors
and main indications of primary caesarean sections and find out ways to reduce
the rising rates. Patients and method: This was a longitudinal and
retrospective study carried out from 1 January 2012 to 31 December 2016. The
study included all patients in whom a primary CS was performed. A previous
uterine scar was a non-inclusion criterion. We analysed the main indications
and their trends during these five years, Apgar score at the 5th minute according to the course of caesarean section rate and the impact of
daily audit. Data were collected retrospectively from 2012 to 2015, then
prospectively in 2016 using a Filemaker database. Data were analysed with SPSS
21 software, Mac version. Averages were calculated for quantitative data and
percentage for qualitative ones. The statistical tests used were the Pearson
Chi2 test. The differences observed were considered significant when the p value was less than 0.05. Results: During the study period, we registered 21.308 deliveries and 6.292 caesarean
sections (29.5%). Primary CS concerned 72.5% of overall CS. The main
indications were suspicious of fetal distress (29.1%), obstructed or prolonged
labour (21.7%), breech and twin delivery with respectively 8.2% and 5.2%. We
registered more vaginal deliveries with induction of labour: 81.4% versus
75.2%. An obstetrical audit allowed better management of labour and decrease of
CS rate. Conclusion: We need to focus on diagnosis of fetal distress, management
of breech presentation in twin delivery and singleton. The induction of labour
can be an effective alternative in some indications. An obstetrical audit is
necessary to reverse caesarean section rate.