Prevalence, influencing factors, and outcomes of emergency caesarean section in public hospitals situated in the urban state of Lagos, Nigeria

Background: Caesarean section (CS) performed in an emergency can be life-saving for both the pregnant woman and her baby. In Nigeria, CS rates have been estimated to be 2.7% nationally, with the highest regional rate of 7.0% reported in the South-West of the country. Our objective in this facility-based retrospective cross-sectional study was to describe patterns and assess factors, obstetric indications, and outcomes of emergency CS in Lagos, Nigeria. Methods: Socio-demographic, travel, and obstetric data of pregnant women were extracted from case notes. Travel data was inputted in Google Maps to extract travel time from the pregnant women’ home to the hospital. Univariate, bivariate and multivariable logistic regression analyses were conducted. Results: Of the 3,134 included pregnant women, 1,923 (61%) delivered via emergency CS. The odds of an emergency CS were significantly higher among women who were booked (OR=1.97, 95%CI 1.64–2.35), presented with obstructed labour (OR=2.59, 95%CI 1.68–3.99), pre-eclampsia/eclampsia (OR=1.67, 95%CI 1.08–2.56), multiple gestations (OR=2.71, 95%CI 1.72–4.28) and travelled from suburban areas (OR=1.43, 95%CI 1.15–1.78). There was an increasing dose-effect response between travel time to the hospital and emergency CS. Conclusion: Optimisation of CS rates requires a multi-pronged approach during pregnancy and childbirth, with particular emphasis on supporting pregnant women living in the suburbs.