Caesarean Section Rate and Indications at Lagos University Teaching Hospital: A Five-Year Review

Caesarean section rates in Nigerian tertiary hospitals have risen substantially in recent years, raising questions about indication patterns, appropriateness, and implications for maternal and neonatal safety. This study reviews the caesarean section rate, indications, and outcomes at Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos State, South West Nigeria over a five-year period. A retrospective review of labour ward and theatre records from 2019 to 2023 identified all caesarean deliveries. Data on primary indication, repeat versus primary caesarean, gestational age, and maternal and neonatal outcomes were extracted and analysed. The overall caesarean section rate was 42.3 percent, rising from 38 percent in 2019 to 46 percent in 2023. Previous uterine scar (28 percent), foetal distress (22 percent), and cephalopelvic disproportion (18 percent) were the three most common primary indications. Emergency caesarean accounted for 61 percent of all procedures. Maternal complications were documented in 8.4 percent, with surgical site infection most prevalent. Perinatal mortality was 4.2 percent among caesarean deliveries. The study identifies a rising caesarean rate at LUTH, driven partly by repeat sections and changing clinical thresholds. Recommendations include a vaginal birth after caesarean (VBAC) programme, indication-based caesarean audit, and multidisciplinary review of clinical decision-making standards to rationalise the caesarean rate at LUTH. Keywords: caesarean section, indications, LUTH, maternal outcomes, birth audit