High Rates of Repeated Caesarean Section Deliveries and its Associated Maternal and Foetal Complications at A Tertiary Hospital in Northern Tanzania

Abstract

ABSTRACT
Background: About one-fifth of women undergo repeated caesarean section (RCS) deliveries worldwide. However, an increase in the number of RCS may lead to maternal and foetal morbidity and mortality. This study aimed to determine the rates of RCS deliveries and associated maternal and foetal complications at a tertiary hospital in northern Tanzania. Methods: This was a hospital-based cross-sectional study conducted at Kilimanjaro Christian Medical Centre (KCMC), Northern Tanzania. A total of 253 women who underwent caesarean section (CS) deliveries during the study period were included. Information from patient files was reviewed to abstract specific variables of interest, including maternal demographic and obstetric characteristics, maternal complications such as adhesions, postpartum haemorrhage, infections, anaesthetic complications, hysterectomy, and maternal deaths. Foetal complications related to RCS were also extracted, including the Apgar score, admission to the neonatal unit, neonatal infections, respiratory problems, and perinatal death.
Result: A total of 253 women were enrolled in this study. Of these, 133 (52.5%) had RCS delivery. The mean (± standard deviation) age of women at enrolment was 29.9 (±6.5) years. The overall complications rate was 56.5% (32.9% among women having first CS and 67.1% RCS, P<.001). For women who underwent RCS, 37.2% had anaesthesia-related complications, including hypotension, nausea, bradycardia, difficult intubation, aspiration, and respiration. Other complications were sepsis (15%), postpartum haemorrhage (PPH) (11.9%), and wound dehiscence (5.5%). Only sepsis was independently associated with repeated CS delivery (adjusted odds ratio (aOR=11.3, 95% confidence interval [CI], 3.3 to 8.9; P<.001).
Conclusion: The reported RCS in this study was high, associated with high CS complications. Necessary measures should be taken by healthcare providers to avoid unnecessary primary CS delivery, and counselling for trial of labour with close monitoring of labour for successful vaginal birth after caesarean section should be emphasised to avoid RCS and its complications.