[Cesarean sections in Senegal: coverage of needs and quality of services].

A prospective study was conducted of all women delivering by cesarean section in Senegals 22 surgical maternity hospitals during 1996. Adequate data were available to include 2269 of the 2436 cesareans performed. 13 hospitals performing 55% of the cesareans were in the Dakar area. Two of Senegals 9 regions had no surgical maternity hospital and 4 had no gynecologists. 19.5% of the mothers were adolescents and the average maternal age was 26 years. 46.5% were primiparous. 64% of the mothers were urban. 65% had at least 3 prenatal consultations and 12% had none. Only 28% were referred for cesareans before the onset of labor and 57% were emergency evacuations. 6.7% of the women had to be re-evacuated from supposedly ultimate referral hospitals due to lack of supplies or personnel. 41% were transported to the hospital in ambulances 14% in private cars and 44% by public transportation. The 2436 cesareans corresponded to a rate of 0.6% of expected births only 20% of the minimum need for cesareans estimated at 3%. Regional cesarean rates ranged from 1.3% in Dakar to 0.1% in Kaolack-Fatick. Feto-pelvic disproportion (30.4%) and fetal distress (18.2%) were the most common indications. 73 maternal deaths occurred for a rate of 3%. 10% of the women had complications with 55% involving infection. There were 9 cases of vesicovaginal fistula. The perinatal mortality rate was 25% with 13% intrapartum and 13% neonatal. Neonatal distress and infection were the main causes of early neonatal death. Accessibility of cesareans is poor both geographically and economically.