Obstetrics long commentary: A prospective study on caesarian section pattern at Kenyatta National Hospital

Abstract

A prospective descriptive surveillance study was carried out between 1st August and 10th November, 1989 on all patients deliveredby caesarian section in the Kenyatta National Hospital's obstetricunit. All patients were interviewed by the investigator and some of the information was obtained from their clinical notes and occasionallyverification was obtained from the doctors who managed themduring labour and delivery. The caesarian section rate was 20%. The ages of these patients nnged from 15 to 48 years. The mean age was 25.9 years. 65.1% of them were between age 20 and 29 years. Majority were married (85.4%) and were of low parity; 72.3 % being between para 1 and para

4. 25% were primiparous. Majority of these women (57.9%) had not undergone caesarian ection prior to this delivery. 3.4% of the cases had not attended any antenatal clinic and majority (48.6%) of those who did, utilizedKenyatta National Hospital antenatal clinic. Majority of ilioseseen in Kenyatta National Hospital antenatal clinic had a highrisk factor for example previous caesarian section scar, bad obstetric history, hypertensive disease of pregnancy diabetesillitus, cardiac disease in pregnancy, etc. The most common indications for caesarian section in this study group include: previoqs scar(41.5%), fetal distress (32.9%), hypertensive disorders of pregnancy (18.3%), cephato- pelvic disproportion (15.2%), breech and other malpresentation (20.7%) and others like bad obstetric history, antipartum haemorrhage, prolonged labour and cord accidents. Majority (69.2%) were delivered at term i.e. 38-42 weeks of gestation and the fetal maternal outcome was good. Majority of the cases were done in good time without any significant delay and the caesarian sections were justified going by the findings at the operation and the fetal-maternal outcome. The few who were delayed were for example, elective caesarian section cases who were awaiting blood and those who awaited the theatre that was at the time being used with other emergencies. The good fetal-maternal outcome in these cases inspite of some delay was probably due to good prioritising of cases in our labour ward theatre based on the individual problem and its severity.