A prospective longitudinal study was carried out of all women undergoing Cesarean section in the surgical maternity hospitals of Senegal between January 1 and December 31 1996. The epidemiology and quality of Cesarean sections were investigated. For each case, the following data were recorded: marital status, prenatal monitoring, conditions of hospitalization, indications for and outcome of surgery, maternal and neonatal follow-up one month after the operation. 2,436 Cesarean sections were performed. Of these, 2,269 cases were indexed and filed and 1,612 received a postnatal checkup one month after the operation. The mean age of the women involved was 26 years. The referral system is not effective, with 58% of patients being rushed to a surgical maternity unit in medically unsuitable forms of transport. Cesarean section is not widely available either geographically or economically. The mean national rate of Cesarean section was 0.6% of expected births but there were differences between regions. The main indications for Cesarean section were the fetus being too large to pass through the pelvic girdle (30%) and fetal suffering (18%). The maternal mortality rate was 3% and one third of the women who died did so immediately after the operation. Maternal morbidity occurred in 10% of cases, mainly due to postoperative infection. The rate of perinatal stress was 25%, most deaths being caused by neonatal distress (33%) or infection (18%). Thus, overall, both the availability and quality of Cesarean section in Senegal are poor.
PIP: A prospective study was conducted of all women delivering by cesarean section in Senegal's 22 surgical maternity hospitals during 1996. Adequate data were available to include 2269 of the 2436 cesareans performed. 13 hospitals performing 55% of the cesareans were in the Dakar area. Two of Senegal's 9 regions had no surgical maternity hospital and 4 had no gynecologists. 19.5% of the mothers were adolescents, and the average maternal age was 26 years. 46.5% were primiparous. 64% of the mothers were urban. 65% had at least 3 prenatal consultations and 12% had none. Only 28% were referred for cesareans before the onset of labor, and 57% were emergency evacuations. 6.7% of the women had to be re-evacuated from supposedly ultimate referral hospitals due to lack of supplies or personnel. 41% were transported to the hospital in ambulances, 14% in private cars, and 44% by public transportation. The 2436 cesareans corresponded to a rate of 0.6% of expected births, only 20% of the minimum need for cesareans estimated at 3%. Regional cesarean rates ranged from 1.3% in Dakar to 0.1% in Kaolack-Fatick. Feto-pelvic disproportion (30.4%) and fetal distress (18.2%) were the most common indications. 73 maternal deaths occurred, for a rate of 3%. 10% of the women had complications, with 55% involving infection. There were 9 cases of vesicovaginal fistula. The perinatal mortality rate was 25%, with 13% intrapartum and 13% neonatal. Neonatal distress and infection were the main causes of early neonatal death. Accessibility of cesareans is poor both geographically and economically.