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An analysis of the use of destructive operation in obstetric practice at the University of Nigeria Teaching Hospital Enugu over a nine year period has been carried out. The hospital is the only Teaching Hospital in the State of six million people, and serves a dual role of tertiary and primary care centre. The incidence of destructive operation fell from 0.29% in the first three years to 0.06% and 0.05% in the second and third year periods respectively. The main indication for the operation was obstructed labour. The incidence of maternal morbidity and mortality was high and was related more to the indications for the destructive operation then the actual operation. Suggested methods for eliminating its use and complications include health education, provision of efficient obstetric services and adequate training of available manpower.

A total of 13,692 deliveries were conducted at University College Hospital, Ibadan. These included 2,764 (22%) cesarean sections, 63 (2.3%) of which were primary elective sections. The case records of 44 of these patients have been analyzed to determine the place of primary elective cesarean section in modern obstetric practice in Nigeria. No maternal deaths occurred and morbidity attributable to the operation was low and not serious. One perinatal death occurred and morbidity was low and less serious than maternal morbidity. There was no record of a uterine scar rupture occurring in subsequent pregnancies in any of these patients. Primary elective cesarean section, if used discriminately, will reduce difficult labor with the attendant risks of maternal and fetal mortality and morbidity in Nigeria and developing countries. The role which improved socioeconomic conditions and health education plays is emphasized.