Caesarian section rates and perinatal outcome at the Aga Khan University Hospital, Nairobi.

BACKGROUND: There has been a persistent rise in the rate of Caesarean sections over the years. Whether this rise is the cause of the decline in infant mortality and improved neonatal outcome still remains debatable. OBJECTIVE: To compare the Caesarian section rate and the perinatal outcome at the Aga Khan University Hospital for the years 2001 and 2004. DESIGN: Retrospective study. SETTING: The Aga Khan University Hospital, Nairobi. MAIN OUTCOME MEASURES: The total Caesarian section rates, their indication and the perinatal outcome. RESULTS: The overall Caesarian section rate was 20.4% in 1996, 25.9% in 2001 and 38.1% in 2004. The rate among patients managed by their private obstetricians was 27.1% in 1996, 30.8% in 2001 and 41.7% in 2004. Whilst among general patients, it was 14.7%, 21.5% and 34.5% over the same period. The main indication for emergency Caesarian section was foetal distress, while that for elective Caesarian section was a previous uterine scar. The overall perinatal mortality rate improved from 25.2 per 1,000 births in 2001 to 14.0 per 1,000 births in 2004 (P< 0.001, 95%CL 8.58-30.62). The early neonatal mortality rate was 12.8 per 1,000 live births in 2001 compared to 10.8 per 1,000 live births in 2004 (p=0.08, 95%CI 9.84-13.76). CONCLUSION: There has been a significant increase in Caesarian section rate over the years. Being a referral unit dealing with many high-risk patients some of whom are supervised elsewhere and with a significant ratio of private patients, the high rate of Caesarean section at the Aga Khan University Hospital is expected. The rise could also be due to early detection of foetal compromise and improved diagnostic facilities leading to timely intervention. However, there has been a significant improvement in the neonatal outcome over the same period of time. Whether this is an effect of the high Caesarean section rate is debatable and calls for further research to correlate the two.