TITLE:
Caesarean Section in African Setting: Current Situation, Problematic and Qualitative Approaches at Laquintinie Hospital (Douala, Cameroon)
AUTHORS:
Essome Henri, Mve Koh Valere, Engbang Jean Paul, Boten Merlin, Essiben Felix, Tocki Toutou Grâce, Foumane Pascal, Mboudou Emile Telesphore
KEYWORDS:
Caesarean Section, Practical, Laquintinie, Cameroon
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.9 No.10,
October
25,
2019
ABSTRACT: Background: Quality control of care aims to reduce or eliminate
unnecessary care and to improve the quality of those who are useful both in
their indication and in their implementation. Objective: We conducted this study to assess the rate of
caesarean section, the rate of irrelevant indications, materno-foetal morbidity and mortality, biases in the management
in order to suggest corrective approaches. Methods: It was a cross-sectional study conducted in the
gynaeco-obstetrics department of the Laquintinie Hospital of Douala over a
period of 4 months from January 1 to April 30, 2017. We included all pregnant women who had a caesarean section and
who gave consent to our study as well as new-borns from these caesareans. We excluded caesarean
deliveries from other health structures and referred to Laquintinie Hospital
due to morbid operative follow-up. The variables collected were grouped under 3 main
headings: socio-demographic data, clinical data and post-operative follow-up. Results: A total of 281 caesarean sections were performed out
of a total of 967 deliveries; a caesarean section rate of 29.06% in 4 months. After
data mining, 250 caesarean sections were included in the study because
31 cases of caesarean deliveries were unusable. Referred pregnancies accounted
for 46.8% of the total population and the most common reason for referral was
stationary labour (23% of cases). All caesareans were performed by the
gynaeco-obstetricians. Women who had caesarean deliveries were informed by the
operator of the surgical procedure in 28.4% of cases and 27.6% were notified of
the indication for surgery. The operative kit was present in 98% of cases. The
operating room was available in 93% of cases. Caesareans were performed mostly
in an emergency context (91.2%) with a median turnaround time of 214 minutes (3 h 56 mins). Mechanical dystocia was the major indication in
our series (21.2%) and 29 indications were irrelevant (11.6%). Intraoperative
complications occurred in 3.2% of cases. Overall maternal mortality (per- and post-operative) was 0.8% (2 cases). We recorded 15 neonatal
deaths out
of which 8 were still births. Regarding the postoperative period, 78% of the
operated patients did not have a good immediate postoperative monitoring. The
post-operative protocol was not respected in 17% of cases. Postoperative
complications occurred in 21.6% of patients with first cause being infections (10.8% with 5.6% being parietal
suppurations). Conclusion: The frequency of Caesarean sections at Laquintinie
Hospital is above the World Health Organization’s recommendations of 5% - 15%. There is a very big delay in the execution time
of emergency caesareans, far above the international standards despite the
quasi-availability of operating kits and the operating theatre. The state of
the premises reveals a sub-workforce creating work overload and therefore a
demotivation of the staff leading to insufficient communication between the operator and operated, a lack of postoperative
follow-up and significant neonatal morbidity and mortality. Hence the need to
initiate a staff satisfaction survey.