Original Articles

Obstetric Outcomes in High-Order Repeat Caesarean Deliveries in Nigeria: A Single-Center Retrospective Study

Abstract

Objective: Our aim was to evaluate the trend of effect of prior caesarean delivery (CD) on obstetric outcomes; and to investigate the existence of a threshold for order of CD associated with geometrical increase in complications.
Materials and methods: We performed a retrospective cohort study of 942 parturients who undergone CD between June 2012 and May 2015 in a teaching hospital in Nigeria. The participants were stratified by the order of caesarean deliveries. We used linear-to-linear association to assess presence of a trend between the order of CD and categorical variables while Jonckheere-Terpstra was used to investigate whether a trend exist between order of CD and continuous variables. We also used multivariate logistic regression to evaluate the relative risk ratio of the outcome variables for each order of CD.
Results: Composite adverse maternal outcome depicted a significant increasing trend from 1st CD (5.2%) to the 5thCD (50%). The relative risk ratio for composite adverse maternal outcome increased arithmetically from 1st CD to 3rd CD: RRR2.21, 95%CI 1.2-3.98 for 2ndCD; RRR3.39, 95%CI 1.60-9.27 for 3rdCD; followed by a geometric increase between 3rdCD and 4thCD (RRR11.64, 95%CI 3.20-18.86). In contrast, composite adverse fetal outcome did not depict a significant trend. However, perinatal death increased significantly from primary CD (4.6%) to 5thCD (33.3%).
Conclusion: Maternal and fetal complications of repeat CD increase with increasing order of CD; and this trend became astronomical after the third CD. Couples should be counselled that both maternal and fetal complications increase with each additional CD and advised strongly to forgo future pregnancies after the 3rd CD.

1. Suja D, Manjusha V, Simi B N, Nazeema A. Study of maternal outcome of emergency and elective caesarean section in a semi-rural tertiary hospital. National journal of medical research 2014; 4: 14-8.
2. Chu K, Cortier H, Maldonado F, Mashant T, Ford N, Trelles M. Cesarean section rates and indications in sub-Saharan Africa: a multi-country study from Medecins sans Frontieres. PLoS One 2012; 7: e44484.
3. Garba NA, Muhammad Z. Caesarean morbidity and mortality at Aminu Kano Teaching Hospital, Kano: a 2-year review. BOMJ 2011; 8: 11-4.
4. Decherney AH, Nathan L, Laufer N, Roman AS. CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 9th edition; McGraw Hill Publishers, 2003.
5. Okafor U, Efetie E, Ibe O.Anaesthesia and Outcome for Caesarean Delivery in the Parturient With Severe Co-Morbidity. The Internet Journal of Anaesthesiology. 2008; 21: 2.
6. Curtin SC, Gregory KD, Korst LM, Uddin SF. Maternal Morbidity for Vaginal and Cesarean Deliveries, According to Previous Cesarean History: New Data From the Birth Certificate, 2013. Natl Vital Stat Rep 2015; 64:1-13.
7. Firoz T, Chou D, von Dadelszen P, Agrawal P, Vanderkruik R, Tunçalp O et al. Measuring maternal health: Focus on maternal morbidity. Bull World Health Organ 2013; 91:794–6.
8. Hembah-Hilekaan SK, Ojabo A, Idogah S. Caesarean Section Rate in a Tertiary Hospital in Makurdi, North-Central Nigeria. General Medicine 2015; 3: 3.
9. Althabe F, Belizan JM. Caesarean section: The paradox. Lancet 2006; 368: 1472-3.
10. World Health Organization. Caesarean sections should only be performed when medically necessary 2015.
11. Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA et al. Maternal morbidity associated with multiple repeat Cesarean deliveries. Obstet Gynecol 2006; 107: 1226-32.
12. Makoha FW, Felimban HM, Fathuddien MA, Roomi F, Ghabra T. Multiple cesarean section morbidity. Int
J Gynaecol Obstet 2004; 87: 227-32.
13. Forde B, DeFranco EA. Association of Prior Cesarean Delivery with Early Term Delivery and Neonatal Morbidity. Obstet Gynecol 2020; 135: 1367-76.
14. Cook JR, Jarvis S, Knight M, Dhanjal MK. Multiple repeat caesarean section in the UK: incidence and consequences to mother and child. A national, prospective, cohort study. BJOG 2013; 120: 85-91.
15. Lynch CM, Kearney R, Turner MJ. Maternal morbidity after elective repeat caesarean section after two or more previ procedures. Eur J Obstet Gynecol Reprod Biol 2003; 106:10-3.
16. Ramadan MK, Ramadan K, El Tal R, Salem Wehbe GR, Itani S, Badr DA. How safe is high-order repeat cesarean delivery? An 8-year single-center experience in Lebanon. J Obstet Gynaecol Res 2020; 46:1370-7.
17. Ezechi OC, Fasubaa OB, Kalu BE, Nwokoro CA, Obiesie LO. Caesarean delivery: why the aversion? Tropical Journal of Obstetrics and Gynaecology 2004;21: 164-7.
18. Adewuyi EO, Auta A, Khanal V, Tapshak SJ, Zhao Y. Caesarean delivery in Nigeria: prevalence and associated factors-a population-based cross-sectional study. BMJ Open 2019; 9:e027273.
19. Sunday-Adeoye I, Kalu CA. Pregnant Nigerian women's view of cesarean section. Niger J Clin Pract 2011; 14: 276-9.
20. Hyginus E, Eric NI, Lawrence I, Sylvester N. Morbidity and mortality following high order caesarean section in a developing country. J Pak Med Assoc 2012; 62: 1016-9.
21. Obuna JA, Ugboma HAA, Ejikeme BN, Umeora OUJ, Agwu UM. Pattern and outcome of higher order caesarean section in a secondary health facility in Nigeria. Research
in Obstetrics and Gynecology 2012; 1: 9-22.
22. Orazulike NC, Alegbeleye JO. Pattern and outcome of higher order caesarean section in a tertiary health institution in Nigeria. International Journal of Tropical Disease & Health 2016; 17: 1-6.
23. National Population Commission (NPC) [Nigeria] and ICF. Nigeria Demographic and Health Survey 2018. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF. 2019.
24. Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet 2000; 356: 1375-83.
25. Tamale-Sali EG, Iskander MN. Is there a risk of lower segment scar rupture in pregnancy after multiple caesarean section? Journal of Obstetrics and Gynaecology 1992; 12: 19-21.
26. Kirkinen P. Multiple caesarean sections: outcomes and complications. Br J Obstet Gynecol 1988; 95: 778-82.
Files
IssueVol 16, No 4 (December 2022) QRcode
SectionOriginal Articles
DOI https://doi.org/10.18502/jfrh.v16i4.11356
Keywords
Caesarean Delivery Complications High-Order Caesarean Delivery Trend

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Okunola T, Bola-Oyebamiji S, Sowemimo O, Ajenifuja K, Kuti O. Obstetric Outcomes in High-Order Repeat Caesarean Deliveries in Nigeria: A Single-Center Retrospective Study. J Family Reprod Health. 2022;16(4):254-263.