Stein W, Katundo I, Byengonzi B
Department of Gynecology and Obstetrics, Georg-August-University, Göttingen, Germany.
Z Geburtshilfe Neonatol. 2008 Dec;212(6):222-5. doi: 10.1055/s-0028-1098735. Epub 2008 Dec 12.
The population-based Caesarean rate in sub-Saharan Africa is very low. The lack of necessary Caesarean sections is an important cause of the high maternal mortality and morbidity in sub-Saharan Africa. The Nyakahanga District Hospital in Western Tanzania showed a persistent and massive increase in the Caesarean rate which was induced by the Rwandan refugee crisis of 1994-1996. We thus examined the question: Is the doubling of the hospital-based Caesarean rate in a rural district hospital in sub-Saharan Africa associated with a change of maternal mortality and morbidity?
All deliveries at the Nyakahanga District Hospital from 1985 to 1999 were included. The study period was divided into the period before and that after the refugee crisis. Caesarean rate, overall uterine rupture, uterine rupture after Caesarean section, maternal death, and stillbirth of both periods were compared.
The mean Caesarean rate increased from 9.4 % in the pre-refugee period to 20.3 % in the post-refugee period. The doubling of the Caesarean rate has been associated with an increase of the rate of uterine rupture from 4.4 to 13.5 per 1 000 deliveries [odds ratio 3.08 (95 % CI 1.97-4.81)]. Uterine rupture associated with previous Caesarean section increased even more [OR 6.3 (1.77-22.42)]. Maternal mortality [OR 1.17 (0.83-1.66)] and stillbirth [OR 0.96 (0.77-1.19)] rates did not change.
The increasing Caesarean rates in rural sub-Saharan Africa might impose an additional hazard of increasing rates of uterine rupture without reducing the rates of maternal mortality and stillbirths.
撒哈拉以南非洲地区基于人群的剖宫产率非常低。缺乏必要的剖宫产是撒哈拉以南非洲地区孕产妇高死亡率和高发病率的一个重要原因。坦桑尼亚西部的尼亚卡汉加区医院的剖宫产率持续大幅上升，这是由1994 - 1996年的卢旺达难民危机导致的。因此，我们研究了以下问题：在撒哈拉以南非洲的一家农村地区医院，以医院为基础的剖宫产率翻倍是否与孕产妇死亡率和发病率的变化相关？
纳入了尼亚卡汉加区医院1985年至1999年的所有分娩病例。研究期分为难民危机前和难民危机后两个时期。比较了两个时期的剖宫产率、总体子宫破裂率、剖宫产后子宫破裂率、孕产妇死亡和死产情况。
剖宫产率的平均值从难民危机前的9.4%上升到了难民危机后的20.3%。剖宫产率翻倍与子宫破裂率从每1000例分娩4.4例增加到13.5例相关[比值比3.08（95%可信区间1.97 - 4.81）]。与既往剖宫产相关的子宫破裂增加得更多[比值比6.3（1.77 - 22.42）]。孕产妇死亡率[比值比1.17（0.83 - 1.66）]和死产率[比值比0.96（0.77 - 1.19）]没有变化。
撒哈拉以南非洲农村地区剖宫产率的上升可能会带来子宫破裂率增加的额外风险，而不会降低孕产妇死亡率和死产率。
