High caesarean section rate: a ten year experience in a tertiary hospital in the Niger Delta, Nigeria.

Background: Caesarean section rate is rising worldwide and Nigeria is no exception.
Methods: This was a descriptive study. The data from case notes, antenatal and theatre records of patients who had caesarean delivery over a ten year period in the Baptist medical center, Eku were extracted and analysed.
Results: The total delivery for the period under study was 5,153 and the total number of caesarean deliveries was 1,777 giving a caesarean section rate of 34.5%. There was no definite trend in the yearly caesarean section rates. Majority of the cases were aged 25-29 (32%). Grandmultipara constituted 26.4% of the patients while 70.1% of cases presented at a gestational age range of 37-42 weeks. Majority of the patients (59.5%) where unbooked for antenatal care. Dystocia (27.1%) was the commonest indication for caesarean section. Emergency abdominal delivery constituted 63.3% of cases while the common complications included wound breakdown, anaemia and endometritis. There were a total of 25 maternal deaths giving a case fatality rate of 1.4%. The leading causes of deaths were haemorrhage (36%), infections (24%), severe preeclampsia/eclampsia (24%), cardiac arrest (12%) and anaesthesia related complication (4%).
Conclusion: This study found a very high caesarean section rate with majority of cases presenting as unbooked emergency cases. High caesarean section rate in this region was due to increase in primary caesarean delivery for dystocia, elective repeat caesarean deliveries and caesarean deliveries for preeclampsia/eclampsia. Future studies should be extended to rural areas and be targeted at determining whole population Caesarean section rates.