Is Caesarean Delivery Safe? Experience from a Low Resource Setting

Objective: In Nigeria, women abhor caesarean delivery because of perceived complications arising from it. We compared the maternal morbidity and mortality associated with caesarean and vaginal deliveries in Port Harcourt, Nigeria to ascertain the safety of caesarean delivery.

Materials and Methods: This was a prospective study of 1000 consecutive caesarean deliveries at the University of Port Harcourt Teaching Hospital, Nigeria over a one-year period. The control group consisted of women matched for age and parity who had spontaneous vaginal delivery after the subject that had caesarean delivery. Information from the case notes was extracted onto a proforma completed by the doctor after delivery. Descriptive and comparative analysis of data generated was done using Epi Info Version 6.04d. Chi-squared test was used to evaluate differences in the morbidity and mortality rates between the two groups.

Results: The caesarean delivery (CD) rate over the study period was 33.1%. Morbidity pattern was similar in both groups in terms of puerperal sepsis (1.1% from CD versus 1.3% from vaginal delivery [VD]) and post-partum haemorrhage (0.6% from CD versus 1.7% from VD). Six maternal deaths occurred among women who had CD, five of which were in those who had emergency CD while five maternal deaths occurred among women who had vaginal delivery. The difference was not statistically significant (p > 0.05).

Conclusion: There was no significant difference in terms of morbidity and mortality between caesarean and vaginal delivery in our tertiary institution. Women in low resource countries should be counseled appropriately so that their aversion towards caesarean delivery will be minimized.