Vaginal Caesarean Section: A Review of Indications in Mali

Introduction: The vaginal caesarean described since the 19th century remains unknown to many practitioners. The publications available on the subject are rare. The objective of this review is to report the experience of our team in Mali on vaginal cesarean section. Materials and Methods: This is a documentary review of a series of 5 cases on the practice of vaginal caesarean section at the Sominé Dolo Hospital and Reference Health Center of the Sanitary District of Bla in Mali between 2005 and 2022. Results: We performed a vaginal caesarean section on 5 patients in this series. The indications were retroplacental hematoma in 2/5 cases including 1 with a live fetus, eclampsia crisis in 1/5 cases, dystocia on uterine prolapse in 1/5 cases and beating cord prolapse in 1/5 cases. In the 5 cases, the pregnancy was not at term. In 3/5 cases, cesarean section was indicated to save the non-term fetus with a very low possibility of success by classic cesarean section and in 2/5 cases for maternal rescue with fetal death in utero. 2 live newborns were released in satisfactory condition, 1 died after 6 hours of life. Antibiotic therapy was not necessary in the majority of cases. The average length of hospitalization was 3 days. Conclusion: The circumstances of the realization of the vaginal cesarean section in our series of studies remain frequent in the practice of modern obstetrics. The short duration of hospitalization and the low use of antibiotics can contribute to the reduction of the medical cost of caesarean section in low-income countries, such as Mali.