Childbirth patterns after previous caesarean birth in sub-Saharan Africa: a retrospective analytical study in two referral hospitals in a semi-urban setting in Cameroon

Abstract

Background: Rising rates of caesarean section (CS) predispose to uterine rupture (UR) during subsequent childbirths. Childbirth after previous CS has poorly been studied in rural Africa. Objective was to describe and analyse the patterns of childbirths after previous CS.Methods: A retrospective analytical study of facility-based deliveries after previous caesarean birth from January 1, 2019 to April 30, 2021 in Bafoussam, Cameroon. We included 416 files of women with previous CS for term singleton pregnancies. Statistics were computed with SPSS®.Results: Mean age and mean parity were 29.9±5.6 years and 3.2±1.4 respectively. Almost half of participants [199 (47.8%)] had had a previous vaginal birth. Antenatal care (ANC) providers were nurses/midwives and general practitioners for 232 (55.8%) and 77 (18.5%) women respectively. The route of delivery wasn’t chosen during ANC for 312 (75.0%) women and 99 (23.8%) of participants were referred during labour. Elective repeat CS was done for 92 (22.1%) women and 324 (77.9%) underwent trial of labour after CS (TOLAC) of whom 131 (40.4%) gave birth by vaginal route. Onset of labour was spontaneous in 304 (93.8%) cases. UR complicated 13 (4.0%) cases of TOLAC. Previous vaginal birth predicted successful TOLAC and referred parturients had higher risk of UR. There were 28 (8.6%) perinatal deaths and 1 (0.3%) maternal death.Conclusions: In our semi urban setting, deliveries after previous caesarean births are unplanned. The success rate of TOLAC is low with a high rate of complications. There is need to improve quality of ANC, birth care and post-natal care for women with previous CS.