Authored by Gabkika Bray Madoué*
Abstract
Background: Caesarean section is a surgical procedure that performs delivery after opening the abdomen and uterus. According to the WHO, the ideal caesarean section rate should be between 10 and 15%. In Chad, the average rate of Caesarean section in urban areas is 9.3% [1]. Despite this rate, enough evidence can be identified to hinder the performance of emergency Caesarean section. That is why we initiated this study in order to see the minimum time required to perform an emergency cesarean section.
Patients and method: This were a descriptive and analytical study that collected prospective data, during a period of 2 months from July 1st, 2019 to August 31st, 2019, about time required to perform an emergency cesarean section and prognosis in N’Djamena Mother and Child University Hospital. All patients at whom emergency cesarean section was performed were included after getting their consent.
Result: During the study period, we record 287 cesareans sections among 845, giving a frequency of 33.9%. Two hundred sixty-one section cesarean was performed in emergency that 90.9%. One hundred and sixty-two patients (62%) were not referred. The average gestational age was 37.7 SA ± 2.9 gestational weeks with extremes of 28 gestational weeks and 42 gestational weeks. Among the 261 emergency Caesarean sections 219 cases (83.9%) were absolute emergencies. The main indications for cesarean section were scarring uterus (24.1%), fetal and maternal disproportion (13.7%), and stagnation of the cervix dilation (13%), eclampsia/preeclampsia (11.4%) perinatal asphyxia (6%). The interval time form indication of caesarean section and fetal extraction was between 90-119 minutes for 117 patients (44.8%). The family refusal was the first reason of the delay representing 19.9%. Beyond 60 minutes of the delay the maternal prognostic is worst. We had recorded 33 complications (12.6%). After 60 mn more fetal complication are noted represented by perinatal asphyxia, neonatal infection and fetal death.
Conclusion: The average time to perform emergency Caesarean section remains high by compared with standards. The family’ refusal of the cesarean section is the first cause of the delay to perform the emergency cesarean section.
Keywords: Emergency caesarean section; Time; Prognosis
Introduction
Caesarean section is a surgical procedure that performs delivery after opening the abdomen and uterus [1]. Globally, there is a disparity in Caesarean section rates, with rates as high as 40% in some areas and 5% in the developing world [2]. According to the WHO, the ideal caesarean section rate should be between 10 and 15% [2]. Regardless of its prevalence, it must be performed within a reasonable time that does not threaten maternal and fetal life. However, there are various factors that can delay it [3]. That is why the literature reported an inequality in the minimum time required to perform a cesarean section. In the same way Lucas [3,4,5], proposed the minimum time for performing cesarean sections according to the codes. In Chad, the average rate of Caesarean section in urban areas is 9.3% [6]. Despite this rate, enough evidence can be identified to hinder the performance of emergency Caesarean section. That is why we initiated this study in order to see the minimum time required to perform an emergency cesarean section.
Patients and Method
This was a descriptive and analytical study that collected prospective data, during a period of 2 months from July 1st, 2019 to August 31st, 2019, about time required to perform an emergency cesarean section and prognosis in N’Djamena Mother and Child University Hospital. All patients at whom emergency cesarean section was performed were included after getting their consent.
Patients were recruited by the medical students without informing the surgeon and other staff member. Then patients and newborns are followed until they are discharged from hospital to identify a complication. The studied variable was epidemiological, clinical and prognoses. SPSS version 18.0 was used to analyze data p value was significant when less than 0.05.
Results
During the study period, we record 287 cesareans sections among 845, giving a frequency of 33.9%. Two hundred sixty-one section cesarean was performed in emergency that 90.9%.
One hundred and sixty-two patients (62%) were not referred. The remainder was referred by surrounding health center (38%) (Table 1).
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