Vaginal delivery after caesarean section in sub-Saharan Africa

Vaginal birth after cesarean delivery in the West African setting

OBJECTIVE

To determine the fetal weight beyond which women with one previous cesarean delivery (CD) are most likely to have a repeat CD.

METHODS

A retrospective cohort study of 586 women who had one previous CD and were undergoing trial of labor was conducted in Accra, Ghana. Following delivery, the women were allocated to one of three groups according to whether they had a successful vaginal delivery, underwent a CD for cephalopelvic disproportion, or underwent a CD for another indication. The groups were then compared using analysis of variance or Kruskal-Wallis tests. Multiple logistic regression was used to assess the effect of fetal weight on the odds of having a repeat CD.

RESULTS

A fetal weight greater than 3.45 kg tripled the odds of having a repeat CD, and the probability of having a repeat CD were 50% for a fetal weight of 3.70 kg.

CONCLUSION

In settings similar to those in Ghana, women who have undergone a previous CD whose fetuses weigh more than 3.70 kg are likely to have less than a 50% chance of having a successful vaginal delivery.

Ruptured uterus: a seven-year review of cases from Accra, Ghana

OBJECTIVE

To determine the incidence, causes, management, and the means of prevention of uterine rupture, as well as the characteristics of women with the condition, recorded in the Department of Obstetrics and Gynaecology at Korle-Bu Teaching Hospital in Accra, Ghana.

DESIGN

A retrospective study between January 1, 1995, and December 31, 2001.

RESULTS

During the study period, of 82061 deliveries at the Korle-Bu Teaching Hospital, 193 women developed uterine rupture, an incidence of 2.4 per 1000 deliveries. Of these 193 women, 24.6% had had a previous Caesarean section. The most frequent associated factor of uterine rupture was prolonged labour (33.6%). The perinatal mortality rate was 74.3%. Almost 70% (66.9%) of women underwent a total abdominal hysterectomy as management. The case fatality rate was 1.0%.

CONCLUSION

A more vigilant approach to preventing prolonged and obstructed labour in delivery units within and around Accra, Ghana, is required to reduce the incidence of this condition.