[Monitoring pregnancy of women with a previous cesarean delivery: qualitative aspects and prognostic implications]

To assess the quality of prenatal monitoring of pregnant women with a previous cesarean delivery and determine the maternal and neonatal prognosis in an African setting.

This prospective, descriptive, and analytical study took place at Roi Baudouin Health Center in Dakar (Senegal) and examined the records of women giving birth from November 1, 2009 to August 31, 2010. It included all women admitted for delivery at 22 weeks of gestation or more, with at least one previous cesarean, and a prenatal consultation record booklet. Women with uterine scars from a gynecological intervention were excluded. The study included a qualitative analysis of the record booklets and an interview of patients.

Women with previous cesareans accounted for 12.5% of all women giving birth during the study period. The average age of the women in our study was 28 years, their mean parity was 3, and their mean number of prenatal examinations 3 (range: 1 to 5). Most prenatal care was provided by midwives (95.1%). The clinical characteristics were rarely completed. Not all women had undergone the laboratory tests required, and fewer than half (40.7%) had had a third-trimester ultrasound. In all, 109 (28.1%) had been referred to the hospital as an appropriate structure for their delivery. Complications of labor were observed in 28.3% of the cases. In 73% of these cases, women had repeat cesareans; 26% had vaginal deliveries. The performance of the recommended prenatal check-up was significantly correlated to how early prenatal care began (p = 0.001) and the level of the structure providing prenatal care (p = 0.027).

Reducing maternal and fetal morbidity and mortality due to uterine scars requires that women be made aware of the relevant issues and that healthcare providers refer them appropriately and early.