Caesarean section at a tertiary institution in Southwestern Nigeria—A 6-year audit

Introduction: Caesarean section is one of the commonest surgical procedures worldwide. Its upward trend and associated morbidity/mortality especially in low-resource setting makes regular appraisal of the practice necessary. Methodology: A retrospective study. Labour ward logbook and case records were looked into, and all information extracted. Results: Caesarean section rate was 35.5%, with an upward trend. Perinatal death was still high. Main indication was previous caesarean section followed by obstructed labour while major maternal morbidity was wound sepsis. Identifiable factors to perinatal death were multiparity, emergency caesarean section and women that were referred to our health facility. Conclusion: Risk appraisal and all efforts must be geared towards reducing caesarean section rate especially in our environment where subsequent deliveries might not be attended to by skilled health personnel.

Terminal fertility control: Clients’ own reason for the choice of the contraceptive method

Background: The prevalence of contraceptive use has increased worldwide due to the development and introduction of modern contraceptives and the establishment of organized family planning programs. In Nigeria, there is a very slow rise in contraceptive use prevalence, resulting in high fertility rate. Generally contraceptive is either used for birth spacing, or for the purpose of terminal fertility control to limit the number of children, and the choice of method for this purpose varies. Aims and Objectives: To determine the contraceptive methods of choice among clients seeking terminal fertility control, and their reasons for the choice of such methods. Materials and Methods: A cross-sectional study of clients attending the family planning clinic of Ladoke Akintola University of Technology Teaching hospital over a period of twenty-four months, between July, 2009 and June, 2011. All clients who had completed their family, and wanted a contraceptive method to limit their family size filled the semi-structured questionnaire after giving their informed consent. Clients’ own reasons for the choice of the particular contraceptive method were grouped, entered into SPSS work sheet, and analyzed using SPSS version 17. Result: There were five hundred and ninety-two new contraceptive method acceptors during the study period, of which 264 (44.6%) were for terminal fertility control. Progestogen-only injectable contraceptive was the method of choice for terminal fertility control by 145 (54.9%) of the clients, while 85 (32.2%) made intrauterine contraceptive device (copper-T) their method of choice, and the least chosen method was female surgical sterilization (2, 0.8%). Ease of administration, satisfaction with previous use, long duration of action, and husband’s preference were the reasons for the choice of the methods. Conclusion: There is awareness of terminal fertility control in Nigeria, especially in the southwestern region of the country, and this may be responsible for the decreasing prevalence of grandmultiparity in the region. However, reversible contraceptive method is the preferred option for this purpose.

Antiseptic Skin Preparation for Preventing Surgical Site Infection at Caesarean Section

Purpose: To compare the effect of chlorhexidine-alcohol and povidone iodine on surgical site infection (SSI) after caesarean section. Methodology: A randomized control trial of 374 patients (188 in the chlorhexidine-alcohol group and 186 in the povidone iodine group) who had elective caesarean section with no overt risk for SSI was done. Patients were followed up until thirty days after delivery to assess for symptoms and signs of SSI. Results: Fifty-one (13.6%) of the study population developed SSI. Although the incidence of SSI was lower in the chlorhexidine-alcohol group than the povidone iodine group (12.2% vs. 15.1%;p = 0.26);the difference was not statistically significant. The incidence of adverse skin reaction in Chlorhexidine-alcohol vs. povidone iodine was also not statistically significant (4.0% vs. 5.4%;p = 0.40). Conclusion: The study demonstrates that there was no statistically significant difference in antiseptic property and side effect profile of chlorhexidine-alcohol and povidone-iodine when used as skin antisepsis in caesarean section.