DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20214312
Published: 2021-10-27

Childbirth patterns after previous caesarean birth in sub-Saharan Africa: a retrospective analytical study in two referral hospitals in a semi-urban setting in Cameroon

Jean Dupont Ngowa Kemfang, Jovanny Tsuala Fouogue, Bronwdown Stachys Nzali, Felicitée Teukeng Djuikwo, André Ngandji Dipanda, Bruno Kenfack

Abstract


Background: Rising rates of caesarean section (CS) predispose to uterine rupture (UR) during subsequent childbirths. Childbirth after previous CS has poorly been studied in rural Africa. Objective was to describe and analyse the patterns of childbirths after previous CS.

Methods: A retrospective analytical study of facility-based deliveries after previous caesarean birth from January 1, 2019 to April 30, 2021 in Bafoussam, Cameroon. We included 416 files of women with previous CS for term singleton pregnancies. Statistics were computed with SPSS®.

Results: Mean age and mean parity were 29.9±5.6 years and 3.2±1.4 respectively. Almost half of participants [199 (47.8%)] had had a previous vaginal birth. Antenatal care (ANC) providers were nurses/midwives and general practitioners for 232 (55.8%) and 77 (18.5%) women respectively. The route of delivery wasn’t chosen during ANC for 312 (75.0%) women and 99 (23.8%) of participants were referred during labour. Elective repeat CS was done for 92 (22.1%) women and 324 (77.9%) underwent trial of labour after CS (TOLAC) of whom 131 (40.4%) gave birth by vaginal route. Onset of labour was spontaneous in 304 (93.8%) cases. UR complicated 13 (4.0%) cases of TOLAC. Previous vaginal birth predicted successful TOLAC and referred parturients had higher risk of UR. There were 28 (8.6%) perinatal deaths and 1 (0.3%) maternal death.

Conclusions: In our semi urban setting, deliveries after previous caesarean births are unplanned. The success rate of TOLAC is low with a high rate of complications. There is need to improve quality of ANC, birth care and post-natal care for women with previous CS.


Keywords


Caesarean, Childbirth, TOLAC, Uterus scar, Uterine rupture, VBAC

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References


Boerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, Juan L, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018;392(10155):1341-8.

Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, et al. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Health. 2015;3:e260-70.

Cragin EB. Conservatism in obstetrics. NY Med J. 1916;104:1-3.

Schell JT. Once a cesarean always a cesarean? NY Med J. 1923;637.

American College of Obstetricians and Gynecologists. Vaginal birth after caesarean delivery. ACOG Practice Bulletin No. 205. Obstet Gynecol. 2019;133:e110-27.

Royal College of Obstetricians and Gynaecologists. Birth after previous caesarean Birth. Green-top Guideline No. 45. London: RCOG; 2015. Available at: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg45/. Accessed on 20 August 2019.

The Society of Obstetricians and Gynaecologists of Canada, SOGC clinical practice guidelines. Guidelines for vaginal birth after previous caesarean birth. Number 155. Int J Gynecol Obstet. 2005;89:319-31.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Birth after previous caesarean section. Available at: https://ranzcog.edu.au/statements-guidelines/obstetrics/birth-after-previous-caesarean-section-(c-obs-38). Accessed on 3 March 2019.

Sentilhes L, Vayssie C, Beucher G, Deneux-Tharaux C, Deruelle P, Diemunsch P, et al. Delivery for women with a previous cesarean: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol. 2013;170(1):25-32.

Reif P, Brezinka C, Fischer T, Husslein P, Lang U, Ramoni A, et al. Labour and childbirth after previous caesarean section recommendations of the Austrian Society of Obstetrics and Gynaecology (OEGGG). Geburtsh Frauenheilk. 2016;76:1279-86.

FIGO position paper: how to stop the caesarean section epidemic. Lancet. 2018;392:1286-7.

Bishop D, Dyer RA, Maswime S, Rodseth RN, van Dyk D, Kluyts HL, et al. Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study. Lancet Glob Health. 2019;7(4):e513-22.

Njim T, Tanyitiku BS, Mbanga C. Prevalence, indications and neonatal complications of caesarean deliveries in Cameroon: a systematic review and meta analysis. Arch Public Health. 2020;78:51.

National Institute of Statistics (INS) and ICF. 2020. Cameroon Demographic and Health Survey 2018. Yaoundé, Cameroon and Rockville, Maryland, USA: INS and ICF. Available at: https://pdf.usaid.gov/pdf_docs/PBAAK341.pdf. Accessed on 3 March 2019.

Mve KV, Belinga E, Elong PA, Toko FB, Tebeu PM. The Mode of delivery of grand multiparous with post-cesarean single uterine scar in low resources settings: A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol X. 2019;4:100078.

Nkwabong E, Fomulu JN, Djomkam YFL. Trial of labor after cesarean section among women with unique lower segment scarred uterus and fetal weight >3500 gm: prognostic factors for a safe vaginal delivery. J Obstet Gynecol India. 2016;66(S1):S202-6.

Mve KV, Essome H, Sama JD, Foumane P, Mengue EB. Vaginal birth after previous caesarean section in low-resource countries: healthcare chain and materno-fetal follow-up. Pan Afr Med J. 2018;30:255.

Tchente NC, Halle-Ekane G, Yaya EAN, Njamen TN, Kamgaing JT, Obinchemti ET, et al. Uterine rupture in Douala General Hospital, Cameroon: Prevalence, risk factors, management and prognosis Health Sci Dis. 2016;17(1):6P.

Fouedjio JH, Ngo DMA, Fouelifack YF, Fouogue TJ. Clinical and therapeutic aspects of uterine rupture in two university hospitals of Yaounde. Health Sci Dis. 2016;17(3):36-40.

Halle-Ekane GE, Djoukam L, Nguefack CT, Tchounzou R, Atashili J. Outcome of delivery after a previous caesarean section at the Department of Obstetrics and Gynecology, Limbe Regional Hospital, Cameroon: a retrospective study. Afr J Integ Health. 2015;5(1):24-30.

Central Bureau of Census and Population Studies of Cameroon. 3rd general census of the population of Cameroon. Population projections. Volume 3. Yaoundé. Available at. http://www.bucrep.cm/index.php/fr/recensements/3eme-rgph/resultas. Accessed on 29 July 2020.

Koulimaya-Gombet CE, Diouf AA, Diallo M, Dia A, Sène C, Moreau JC, et al. Pregnancy and childbirth of patients with a history of cesarean section in Dakar: epidemiological-clinical therapeutic and prognostic aspects. Pan Afr Med J. 2017;27:135.

Seffah JD, Adu-Bonsaffoh K. Vaginal birth after a previous caesarean section: current trends and outlook in Ghana. J West Afr Coll Surg. 2014;4(2):25.

Ugwu GO, AIyoke C, Onah HE, Egwuatu VE, Ezugwu FO. Maternal and perinatal outcomes of delivery after a previous cesarean section in Enugu, Southeast Nigeria: a prospective observational study. Int J Wom Health. 2014;6:301-5.

WHO Regional Office for Africa. Health topics: Maternal Health. Available at: https://www.afro.who.int/health-topics/maternal-health. Accessed on 30 December 2020.

Fouelifack FY, Fouedjio JH, Ngowe F, Tebeu PM, Fouelifa DL, Fouogue TJ. Therapeutic path of parturients admitted with uterine rupture at the Yaoundé Central Hospital. Health Sci Dis. 2019;20(1):39-45.

National Institute of Institute of Statistics and ICF. 2020. Demographic and health Survey- Cameroon. 2018. Yaounde, Cameroon and Rockville, Maryland, USA: NIS and ICF. Available at: https://pdf.usaid.gov/pdf_docs/PBAAK341.pdf

Senturk MB, Cakmak Y, Atac H, Budak MS. Factors associated with successful vaginal birth after cesarean section and outcomes in rural area of Anatolia. Int J Wom Health 2015;7:693-7.

Kabore C, Chaillet N, Kouanda S, Bujold E, Traore M, Dumont A. Maternal and perinatal outcomes associated with a trial of labour after previous caesarean section in sub-Saharan countries. BJOG 2016;123:2147-55.

WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture. BJOG Int J Obstet Gynaecol. 2005;1221-8.

Meka ENU, Foumane P, Essiben F, Ngwesse ER, Dohbit JS, Mboudou ET. Predictive factors of complications of vaginal delivery on scarred uterus at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital. Open J Obstet Gynecol. 2016;6(13):851-60.