Is the pregnancy and delivery complication rate leading to operative

Abstract

Background: Previous degree projects at Kilimanjaro Christian Medical Center (KCMC) have shown high rates of caesarean sections (CS) 40.8 per cent 2016 and 47.4 per cent 2017. The World Health Organization recommend CS rate to stay at 10-15 per cent. The explanation from the clinic has been that the high rate of more complicated referral patients is the reason for the increasing CS rate. Aim: To analyse whether indications among referral patients are medically more complex compared with reasons for attending the delivery ward among the non-referral patients. To analyse if the rate of delivery complications and the frequency of operative delivery is higher in the referral group than among the non-referral patients. Methods: This is a descriptive and cross-sectional study. Data were collected at labour ward for 5.5 weeks from delivery records and a medical birth registry with focus on reason for attending, complications leading to intervention and mode of delivery. Results: 234 women were included, 79.9 per cent Non-Referrals and 29.1 per cent Referrals. Among Non-Referrals the CS rate was 41.6 per cent and among Referrals the corresponding rate was 73.5 per cent. The total CS rate were 50.9 per cent (p-value <0.001). Complication rate among Non-Referrals were 28.9 per cent of all deliveries. Corresponding rate among Referrals were 58.8 per cent (p=0.003). Conclusions: Reasons for attending delivery ward are more complicated in terms of higher frequencies of maternal diseases and medical complications during pregnancy among Referrals than among Non-Referrals. There was higher rate of complications leading to CS among Referrals than among Non-Referrals. The CS rate has also further increased since last year and is highest among Referrals. Key words: Delivery outcome. Complications leading to intervention. Caesarean section. KCMC. Tanzania.