Caesarean Delivery: The Trend Over a Ten-Year Period at Ilorin, Nigeria

Background: There has been tremendous increase in caesarean deliveries in modern obstetric practise as a result of extension of the indications for caesarean section, which is now an international public health issue. Method: Records of all caesarean deliveries that occurred at University of Ilorin Teaching Hospital (U.I.T.H.) between 1st January 1990 and 31st December 1999 were reviewed retrospectively. Results: Two thousand, seven hundred and sixty-four caesarean births occurred out of 30,267 deliveries giving an overall caesarean section rate of 9.1%. Caesarean birth rose from 1 in 26 deliveries in 1990 to 1 in 5 deliveries by 1999. Cephalopelvic disproportion, 851 (30.8%) remained the commonest indication for caesarean section throughout the study period. The other indications were antepartum haemorrhage 363 (13.1%) and pre-eclampsia/eclampsia, 258 (9.3%). The common causes of caesarean section related maternal mortality were sepsis, 9 (31.0%), haemorrhage 8 (27.6%), anaesthesia 4 (13.8%) and embolism 4 (13.8%). There were 29 and 12 maternal deaths following caesarean section and vaginal delivery respectively. All caesarean mortality cases recorded were under emergency situations. Maternal mortality ratio relating to caesarean section (1,050 per 100,000) was higher than that for vaginal delivery (40 per 1000). The difference was statistically significant (p < 0.0). Conclusion: Caesarean section rate has dramatically increased during the study period. This high caesarean birth and caesarean mortality can be reduced by improving socio-economic condition of the populace, strict policy on active management of labour, improve blood transfusion services and anaesthetic technique in this centre. (Nig J Surg Res 2001;3:11-18) KEY WORDS: Caesarean delivery; trend; Ilori