Ngao Anastazia J, Obure Joseph, Maro Eusebious William, Damian Damian J
Kilimanjaro Christian Medical University College, Moshi, Tanzania.
Department of Obstetrics and Gynaecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
East Afr Health Res J. 2024;8(1):74-79. doi: 10.24248/eahrj.v8i1.751. Epub 2024 Mar 28.
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.
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.
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, ). 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; ).
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.
全球约五分之一的女性接受重复剖宫产（RCS）分娩。然而，RCS数量的增加可能导致孕产妇和胎儿的发病率及死亡率。本研究旨在确定坦桑尼亚北部一家三级医院的RCS分娩率以及相关的孕产妇和胎儿并发症。
这是一项在坦桑尼亚北部乞力马扎罗基督教医疗中心（KCMC）进行的基于医院的横断面研究。共纳入了253名在研究期间接受剖宫产（CS）分娩的女性。查阅患者病历信息以提取感兴趣的特定变量，包括孕产妇人口统计学和产科特征、孕产妇并发症，如粘连、产后出血、感染、麻醉并发症、子宫切除术和孕产妇死亡。还提取了与RCS相关的胎儿并发症，包括阿氏评分、入住新生儿病房、新生儿感染、呼吸问题和围产期死亡。
本研究共纳入253名女性。其中，133名（52.5%）接受了RCS分娩。入组时女性的平均（±标准差）年龄为29.9（±6.5）岁。总体并发症发生率为56.5%（首次剖宫产女性中为32.9%，RCS女性中为67.1%）。接受RCS的女性中，37.2%有麻醉相关并发症，包括低血压、恶心、心动过缓、插管困难、误吸和呼吸问题。其他并发症为败血症（15%）、产后出血（PPH）（11.9%）和伤口裂开（5.5%）。只有败血症与重复剖宫产分娩独立相关（调整优势比（aOR = 11.3，95%置信区间[CI]，3.3至8.9））。
本研究中报告的RCS率较高，与较高的剖宫产并发症相关。医疗保健提供者应采取必要措施避免不必要的初次剖宫产分娩，并应强调进行剖宫产术后阴道分娩试产的咨询以及对分娩进行密切监测以实现成功阴道分娩，以避免RCS及其并发症。
