[Indications for cesarean section and their outcome at the Hospital Center in Libreville]

Abstract

Over a 16-year period and 113,739 deliveries, the rate of caesarean sections in the Department of Gynecology-Obstetrics of the Centre Hospitalier of Libreville (Gabon) reaches 1.79 p. cent. Since 1985, there is a highly significant (p less than 0.001) of that rate reaching 2.33 p. cent. A comparative study of two 4-year periods (1981-1984 and 1985-1988) permits to analyze the evolution of caesarean sections. The increase is the result of an improved diagnosis of the pathology during pregnancy, especially pre-eclampsia (6.2 p. cent of indications), a better obstetrical monitoring in pelvic deliveries (7 p. cent) and screening of fetal distress (11 p. cent). The indications remain stable in mechanical dystocias and placenta praevia (40 p. cent) and for scarred uterus (19 p. cent) the rate of which remains at 1 p. cent of the deliveries. The decreased rate of perinatal mortality which has benefited from the improvement of the quality of care is not directly related to the increased rate of caesarean sections: in Africa, caesarean sections are still performed in harmful conditions for saving the mother. Maternal mortality remains high (160 of 100,000 NB) and the mortality of caesarean sections is 9 for 1,000, with only 4 p. 1,000 related to the C. section itself and not to the pathology requiring the procedure. The mortality of caesarean section is 5 times higher than that of vaginal deliveries. Caesarean sections results in uterine ruptures during subsequent pregnancies (2 p. cent of scarred uterus). The increased of caesarean sections may only be considered within the scope of concomitant improvement of prenatal monitoring, obstetrical monitoring and neonatal medicine.