Trends of different forms of anaesthesia for caesarean section in South-eastern Nigeria

Summary

General anaesthesia is recognised as a cause of maternal mortality/morbidity in caesarean deliveries, and regional anaesthesia is believed to reduce anaesthesia-related maternal/fetal morbidity and mortality. The aim of this study is to present the trends of different forms of anaesthesia for caesarean section in Eastern Nigeria. We conducted a retrospective survey of hospital records of caesarean deliveries in this unit over a 4-year period from January 2003 to December 2006. There were 2,968 deliveries and 3,140 births (2,959 live births), with 729 women (24%) delivered by caesarean section. There was a yearly increase in the use of regional anaesthesia from 18% in 2003 to 48% in 2004 and 72.6% in 2005, but it fell to 71% in 2006. There were 59 stillbirths giving a stillbirth rate of 81/1,000 caesarean deliveries. The total number of stillbirths in the hospital during the study period was 179 giving a stillbirth rate of 60/1,000 deliveries. A total of 42 (71%) stillbirth deliveries were associated with general anaesthesia and 17 (29%) associated with spinal anaesthesia. Of the 32 neonates with an Apgar score of 3–5 at 5 min after birth, 21 (66%) delivered under general anaesthesia and 11 (34%) delivered under spinal anaesthesia. There were eight hysterectomies in patients with ruptured uterus, all under general anaesthesia. There was one maternal death in a patient who was delivered under general anaesthesia. The fetal loss in this study is high and may indicate that most data on stillbirths from parts of the developing world may be underestimates. In conclusion, in developing country such as Nigeria there is a changing trend towards the use of regional anaesthesia during caesarean section. Its use should be encouraged in the developing world, especially resource-poor environments because it is cheaper to provide.

Keywords:

• Anaesthesia
• caesarean section
• developing countries