Paper Title: Perinatal outcome among unbooked patients following Caesarean section
Authors: Eli S, Oriji V, Abam D.S, Ikimalo J.
Context: Caesarean section (Cs) is performed in the interest of the health of the fetus, mother or both. To identify areas of improvement, a review of fetal outcome of these surgeries is important. Objective: This study was to determine fetal outcomes among un-booked mothers requiring caesarean deliveries. Study Design, Setting and Subjects: A three-year retrospective study of fetal outcome of caesarean deliveries in un-booked mothers atthe University of Port Harcourt Teaching Hospital. Main Outcome Measures: Perinatal asphyxia and perinatal deaths. Results: There were 863 Cs performed for 863 singleton births. A total of 841 were emergency Cs. Birth asphyxia occurred in 34.9% of the deliveries. The early neonatal death rate was 192.5/1000 live births and the fresh still birth rate was 319.8/1000 live births. The preterm deliveries and emergency Cs were significantly associated with higher rates of asphyxia and fresh still births (p<0.005).Hypertensive diseases and antepartum haemorrhage as indications for Cs were also significantly associated with increased perinatal mortality (38.3% and 33.4%). Those referred from TBA had the highest perinatal mortality (24.1%). Hypertensive disorders of pregnancy and antepartum haemorrhage were the indications for surgery most frequently associated with perinatal mortality. Conclusion: These high rates of adverse perinatal outcome with emergency Cs and prematurity are possibly due to type 1 delay and complications of preterm deliveries respectively and these two factors synergize when they occur together. We recommend enlightenment of TBAs towards early referrals and improvements in the neonatal units to reverse these trends.