The quality of supervision during vaginal delivery- is there an impact on caesarean section rate?

Abstract

Background: An increasing caesarean section (CS) rate is seen in Africa. In a preliminary report from 2017 at Kilimanjaro Christian Medical Centre (KCMC) it was demonstrated an increased CS-rate from 40.8 in 2016 to 47 per cent last year. Inadequate use of partograph can lead to delayed diagnosis of prolonged dysfunctional labour or late detection of disproportion as well as defaulted foetal heart rate auscultation. Is it possible that this has an impact on the caesarean rate in KCMC? Aim: To compare the documentation of supervision of mother and child during childbirth leading to vaginal delivery with that of patients ending up with a caesarean section in three groups with expected vaginal delivery. Methods: This is a descriptive cross sectional study. Information needed for the study was collected from the delivery book, medical records and the Medical Birth Registry from women giving birth during the data collection time at KCMC. Results: The rate of well plotted partographs was 28 per cent in total of included patients. The CS-rate was 12 per cent among the well plotted partographs and 27 per cent among the not well plotted partographs. The most seldom well plotted parameter in the partograph were pulse (13%) and temperature (47%). Cervical dilatation (86%), amnionic fluid (85%) and head descent (83%) were the most well plotted parameters. Foetal heart rate was well plotted only in 69 per cent. Conclusion: The rate of well plotted partographs was low (28%) at KCMC. Not well plotted partographs had more than twice as high CS-rate compared to well plotted labours. The difference was not significant, perhaps due to a small study group. The importance of a well plotted partograph should be emphasized at the department. Key words: caesarean section rate, supervision of labour, well plotted partograph, KCMC, Tanzania