Indications s of cesarian by robson classification in adolescents from 2005 to 2015 at Health Center Nabil Choucair

Abstract

Objectives: The objective of our study is to determine the frequency of caesarean section in the Nabil Choucair Health Center maternity center in Dakar, Senegal; to identify the epidemiological profile of our patients; to study clinical data; to analyze indications for caesarean sections performed in teenage girls and finally; make recommendations to improve the quality of the caesarean section.
 Materials and methods: This was a retrospective, descriptive study of adolescent cesarean section indications from January 1, 2005 to December 31, 2015 for a period of 11 years. The study population is made up of all parturients whose age group was less than 19 years admitted to the Maternity Center Nabil Choucair for childbirth. The data was collected through the study of medical records, birth records, operational records and anesthesia cards. The studied parameters were: the epidemiological profile (age, gestationality, parity, data at admission); prenatal follow-up; clinical examination data; indications for caesarean section; operative and postoperative data as well as neonatal data. Patients were divided according to Robson's 10group classification. The capture was carried out thanks to the Sphinx version 5 software and the analysis thanks to the software SPSS version 20.0.
 Results: During the study period, we recorded 9140 caesareans at the Nabil Choucair Health Center in Dakar. 264 cesarean sections were performed in adolescents, giving a frequency of 2.9% compared to all cesarean sections performed.71.2% of adolescents were over 16 years of age. The average age of teenagers was 17.3 years with extremes of 13 and 19 years. The mean gestational age was 1.2 with extremes of 1 and 4. Primigestes accounted for 84.5% of patients, 12.5% ??of adolescent girls were at least their second pregnancy. While 2% of teenage girls were already multigestes. The average parity was 1.1. Primiparous women accounted for 85.6% of patients; the pauciparas 14% and the multiparas 0.4%. In antenatal care 45% had done at least 4 prenatal consultations during pregnancy, 44.3% had an ultrasound and the prenatal report was complete in only 69.4%. At admission Almost all the patients (91.6%) of the patients were in labor. Most patients had an abnormal pelvis (66.2%). The pelvis was generally narrowed in 101 patients (38.2%). Of these 60 patients (22.7%) had an immature pelvis and 5.2% (13 patients) had a limited pelvis. The pelvis was clinically normal in 71 patients (27%). However, for 18 patients (6.8%), the pelvis assessment was not included in the medical file. Analysis of the indications according to Robson's classification revealed that the first 4 groups of the classification were the most represented (229 adolescent girls, 86.7%). Group 1 alone comprised 204 patients (77.3% of indications). The last 6 groups included 29 patients or 11.2% of the indications for cesarean section. In group 5, there were 11 patients (4.3%) and consisted of multiparas 
with previous cesarean section, with a single pregnancy in cephalic presentation. These 29 adolescent girls were considered "at high risk of cesarean section. According to the Robson Classification.
 Conclusion: The indications for caesarean section in adolescents must be well laid to avoid compromising the obstetrical future.