Background: Cesarean section (CS) is a procedure that can be life saving in many cases. In several developing countries the procedure is scarcely performed, while it is overly performed in many high- and middle-income countries. The World Health Organization recommends a cesarean section rate of 10–15%. In Ghana the rate for CS is 6.9%. The aim of the study was to determine the indications for CS and identify the characteristics of women undergoing CS at the Korle Bu Teaching Hospital (KBTH) in Accra, Ghana.
Method: The study was cross sectional and compromised of two parts, both taking place at the KBTH. All CSs from 08.12.2010 until 10.02.2011 were recorded, and their indications and outcomes registered. The first 348 CSs were retrospectively looked into, while from 17.01.2011, 200 women undergoing CS were interviewed regarding their socioeconomic background, using a semi-structured questionnaire.
Results: In the period from 08.12.2010 until 10.02.2011 there were 548 CSs; 70% were emergency and 30% were elective. The main indications were previous CS (37.6%), fetal distress (9.1%) and fetal malpresentation including breech (8.6 %). Only 0.2% were due to maternal request. Younger women and nulliparas had significantly more emergency CSs than older women and multiparas. The nulliparas tended to have difficult labors, with higher rates of the indications ‘failure in progress’ and ‘arrest of labor’. There was a significantly higher rate of elective CSs in the socioeconomic benefited group compared to the lower class group. The outcome of singletons shows us that 46% were female infants and 56% male infants.
Conclusion: The main indications of CS at the KBTH reflect indications necessary to good obstetric care. There were very few non-absolute indications; only one CS was performed on the indication maternal request. This reflects a developing country with low health resources. Due to a lack of diagnostic equipment as CTG and fetal scalp sampling, indications such as fetal distress might be over-diagnosed. Elective CSs had a significantly higher rate in the upper socioeconomic class, suggesting that class influences the decision to having the procedure.