Cesarean section in rural areas of Kasaï Oriental (DR Congo): Participation of indications in the monthly evolution of rates in Kasansa and Tshilenge

Abstract

Cesarean section is recognized as an effective surgical intervention to reduce maternal and newborn mortality if performed in a timely manner for pregnant women who really need it. This study analyzed the contribution of indications to the monthly evolution of cesarean section rates in rural Kasai Oriental. This retrospective descriptive bi-center study focused on 434 cesarean sections performed in the Kasansa and Tshilenge General Reference Hospitals in 2015 and 2016. To compare the percentages, Chi-square was used, t-Student for the means in the two maternity hospitals and the percentage changes were calculated with the growth formula. Despite the inflationary trends observed during the year, all groups of cesarean section indications ended the year in decline. In 2015, 11±3 caesareans were recorded in Kasansa with an inflation of 220% for emergency caesareans. In Tshilenge, 6±3 caesareans were performed and 100% inflation for emergency caesareans. In 2016, on average, the Kasansa maternity unit performed 9±5 caesareans per month and in Tshilenge, 10±4 caesareans. Cautionary caesareans had an inflation of 169.1% in Kasansa, while in Tshilenge, it was the inflation of emergency caesareans with 100%. According to the different classes of indications, in 2015, the notable increases in caesareans were recorded for uterine rupture (150%), breech presentation (100%) and PROM (200%). In 2016, dystocic presentations increased cesarean sections (180%), scarred uterus (600%) and eclampsia (200%). The practice of cesarean sections has decreased in both structures in general. Certain indications have particularly contributed remarkably to the increase in cesarean sections. Proper monitoring of the pregnancy will avoid cesarean sections for indications of necessity considered abusive.