Cesarean section: One procedure, varied techniques. Detailed observations of 1013 first cesarean sections in a tertiary hospital in Ghana

Objective: Cesarean sections (CS) are among the most performed surgical procedures in the world. Small variations in surgical techniques could have a significant impact on a global scale, for example, in postoperative complications. In the present study we aimed to observe and audit every single step used during first time CS.

Methods: Descriptive cross-sectional study from January 1, 2018 to January 14, 2020 at a tertiary hospital in Ghana. Techniques used for CS were directly observed and thoroughly documented. Standard descriptive methods were used for data analysis.

Results: Of the 1013 first time CS, 81.4% were emergency procedures. The mean (SD) gestational age at CS was 38.4 ± 3 weeks. Low transverse incision was used in 993/1013 (98%) of cases. Blunt dissection of subcuticular tissue was done in 48/1013 (4.7%), blunt separation of rectus fascia in 386/1013 (38.1%), blunt opening of peritoneum in 838/1013 (82.7%) and lower uterine segment incision with scalpel in 995/1013 (98.2%) women. A total of 916/1013 (90.4%) had double layered uterine closure, 961/1013 (94.9%) had uterus exteriorized for repair, 382/1013 (37.7%) had closure of the peritoneum, 655/1013 (64.7%) had non-closure of the rectus muscle, 677/1013 (66.8%) had subcutaneous tissue closed and 983/1013 (97.0%) had skin closed with subcuticular stitches. There were 493 different combinations of techniques observed performed by 85 surgeons for carrying out a complete first time CS.

Conclusion: There is a wide variety of methods used for first time CS. There is the need for training and retraining on the techniques for CS using evidence-based guidelines.