Caesarean Section Techniques among Senior Obstetricians in Nigeria: A Descriptive Multicentre Survey

Background: Caesarean section (CS) is one of the most commonly performed surgical procedures worldwide, yet considerable variation exists in operative techniques, particularly in low and middle-income countries. The aim of this study is to determine the common surgical techniques employed by senior obstetricians in Nigeria and evaluate the associations with demographic and institutional factors. Methods: A descriptive cross-sectional multicentre online survey was conducted between May 2023 and May 2024 among practising Senior Registrars and Consultants in Obstetrics and Gynaecology across Nigeria. Using a structured, pretested questionnaire, data were collected on sociodemographic characteristics, preoperative, intraoperative, and postoperative CS practices. Data were analysed using R statistical software, with descriptive statistics and multivariate analyses performed. Statistical significance was set at p < 0.05. Results: A total of 293 complete responses were analysed. The mean age of respondents was 42.1±7.6 years, with a mean work experience of 11.9±6.4 years; 66.6% were male, and 78.8% practiced in federal tertiary hospitals. The most commonly reported techniques included skin preparation with Savlon plus alcohol (73.4%), Pfannenstiel abdominal incision (71.0%), bladder flap creation (73%), controlled cord traction for placental delivery (68.9%), double-layer uterine closure (99%), visceral peritoneal closure (60%), and subcuticular skin closure (96.6%). Routine postoperative thromboprophylaxis was used by only 18.4% of respondents. Most surgical choices were not significantly associated with age, work experience, or place of practice, except for visceral peritoneal closure, which varied by institution (p = 0.043). Conclusion: CS practices among obstetricians in Nigeria showed some consistency in key operative steps such as Pfannenstiel incision, double-layer uterine closure, and subcuticular skin closure, alongside notable variation in other aspects, particularly thromboprophylaxis use. These findings highlight the influence of institutional practice patterns and underscore the need for context-specific, evidence-based guidelines to harmonise CS techniques and optimise maternal outcomes nationwide.