Pattern and Outcome of Higher Order Caesarean Section in a Tertiary Health Institution in Nigeria

Objective: To determine the rate, pattern and outcome of higher order caesarean section (HOCS) in a tertiary health facility.

Materials and Methods: A retrospective study of 182 women who had undergone three or more caesarean sections at the obstetric unit of the University of Port Harcourt Teaching Hospital, (UPTH) Nigeria, between January 1, 2008 and December 31, 2014 was conducted. Data obtained from the theatre records and case notes of patients were analysed using the statistical package SPSS 20.

Results: Over the 7-year period under review, there were 20,258 deliveries. The overall caesarean section rate was 42.7%. The rate of HOCS per total caesarean section was 2.1%. Of the 182 higher order caesarean section, 114 (62.6%) were emergency HOCS and 68 (37.4%) were elective. The perinatal mortality rate from emergency higher order caesarean section was high (36.4/1000). There was no perinatal death with elective caesarean section. Major degree placenta praevia was the commonest antenatal complication while severe anaemia from primary post partum haemorrhage was the commonest post partum complication, The maternal mortality ratio was 549.1/100,000. There was no maternal death from elective higher order caesarean section. The proportion of higher order caesarean section that was done as an emergency was high with associated feto-maternal morbidity and mortality.

Conclusion: Higher order caesarean section was associated with increased feto-maternal morbidity and mortality especially when unplanned. Women should be encouraged to accept planned repeat caesarean section when they have had two or more.