Caesarean section rates in an African country

Autor: De Muylder X, Amy Jj
Rok vydání: 1993
Předmět:
Zdroj: Paediatric and Perinatal Epidemiology. 7:234-244
ISSN: 1365-3016
0269-5022
DOI: 10.1111/j.1365-3016.1993.tb00401.x
Popis: The use of caesarean section (C.S.) has been analysed in the 12 hospitals of the Midlands Province of Zimbabwe during a 2-year period. Maternal mortality rate, perinatal mortality rate, low birthweight rate, percentage of high risk pregnancy, C.S. rate and instrumental delivery rate have been extracted for each hospital. The rate of C.S. delivery varied between 2.2 and 16.8 per 100 deliveries but was not correlated with the number of high-risk pregnancies. Increased use of C.S. was not linked to better perinatal results. An important determinant of the C.S. rate appears to be the physician and the ratio between the rate of instrumental deliveries (ID) and C.S. differentiated the 12 hospitals into two groups. Although there was no difference in the number of high risk patients in these two groups, outcomes were much better in the hospitals with a high ID rate than in the hospitals with a high C.S. rate, suggesting that attitudes of medical staff can influence both the mode of delivery and the perinatal outcome in a developing country.All deliveries recorded during the years 1985 and 1986 in the 12 hospitals in Midlands Province were analyzed. For each hospital, the number of high-risk pregnancies was defined according to risk list together with the number of primigravidas. Maternal mortality, perinatal mortality, and low birth weight (LBW; with cut-off value set of 2000 g) were recorded. There was a good correlation between the number of high-risk pregnancies and the perinatal mortality rate or LBW rate. The frequency of Cesarean section (CS) rate varied between 2.2% in Hospital 8 and 16.8% in Hospital 1. However, there was no relationship between the CS rate and the number of high-risk pregnancies for a given hospital. In contrast, there was a positive correlation between the rate of CS and the perinatal mortality rate. A hospital with a higher rate of CS resorted to abdominal delivery more frequency for the ill-chosen indications of unknown presentation, retained second twin, or delivery of a stillborn child. Hospitals with a higher number of instrumental deliveries (ID) (vacuum extraction, forceps, symphysiotomy, embryotomy) tended to have a reduced number of CS and vice versa. The use of ID was inversely proportional to the CS rate, leading to an ID/CS ratio varying between 0.03 and 1.24. The number of LBW infants and high-risk pregnancies were comparable in the 6 institutions with an ID/CS ratio higher than 0.2 as opposed to the 6 hospitals with a ratio of less than 0.2, but both the perinatal and the maternal mortality rates were statistically higher to the hospitals with ID/CS ratio below 0.2. Hospitals recorded very dissimilar CS rates not related to the obstetric risk, and hospital with a higher CS rate had not better obstetric results than the other hospitals. Similarly, the CS rate for breech presentation varied between 5 and 30%. Hospitals with a higher ID/CS ratio had lower maternal and perinatal mortality rates. CS should be the last resort.
Databáze: OpenAIRE
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