Trends and Outcomes of Cesarean Delivery in Ayder Comprehensive Specialized Hospital, Mekelle City, Northern Ethiopia

Abstract

Background: Rising rates of cesarean delivery is becoming a concern to developing countries. Though cesarean section is a life saving surgical intervention, the rise in rates has resulted in significant health problems of mothers and newborns.
Objective: The aim of this study was to describe trends and outcomes of cesarean delivery in Ayder comprehensive specialized hospital, Mekelle City, Northern Ethiopia.
Methods: Hospital based record review cross-sectional study was conducted in Ayder comprehensive specialized Hospital, Mekelle City, Northern Ethiopia from September 11, 2011 to September 10, 2016. Trained data collector and the principal investigator collected data employing a pre-tested extraction format. After checking the filled extraction format for completeness, data was entered, cleaned and analyzed using SPSS software Version 23. Chi- square test, 95% CI and P-value <0.05 was used to examine association between dependent and independent variables.
Result: In five years time (2011-2016), there were 9,348 deliveries, of which 2,911 were delivered by cesarean section which gives the overall rate of 31.1%. The cesarean delivery rate was increasing from 25.2% in 2011/2012 to 33.5% in 2015/2016 with an average annual increment of 1.7%. The most common indications for cesarean section were non-reassuring fetal heart rate pattern (22.8%), cephalo-pelvic disproportion (21.1%), and repeat cesarean delivery (14.0%) respectively, which accounts for more than half of the cesarean sections. The common maternal morbidities after cesarean delivery in the study result were anemia (37.2%) mainly those anemic before delivery and had antepartum hemorrhage; postpartum hemorrhage (3.7%), surgical site infection (1.9%), iatrogenic internal organ injury (bladder, ureter and bowel) (0.8%), and uterine vasculature laceration (0.9%). There were 4.7% stillbirths mainly in women with obstructed labor and antepartum hemorrhage, 1.8% early neonatal deaths despite resuscitation in the operation theatre before referral to neonatal intensive care unit, and 16.1% of neonates had fifth minute Apgar score of less than 7 with 12.2% of neonates admitted to neonatal intensive care unit.
Conclusion and recommendation: In this study, there is a steady increase in the rates of cesarean delivery in five years time, and complications of post-cesarean delivery are common. Further studies are necessary to investigate the factors that increase the rate of cesarean delivery and post-operative complications. Policies and efforts aimed at decreasing the unnecessary cesarean sections and its complications should be promoted and implemented at each health facility.