TY  - BOOK
AU  - Clement Sobe Morabu
AU  - Dismas Matovelo
AU  - Anthony Massinde
AU  - Benson Kidenya
TI  - Associated Factors for Pregnant Women with More Than One Previous Caesarean Sections Coming for Delivery While in Labor in Selected Hospitals in Mwanza Region Tanzania
PY  - 2018///
CY  - Mwanza, Tanzania:  
PB  - Catholic University of Health and Allied Sciences [CUHAS - Bugando]
KW  -  
N2  - Abstract: 

Background: It is clearly documented that emergency caesarean section for women with two or more previous caesarean scar is associated with poor fetomaternal outcomes. The WHO and MoHCDGEC recommend elective caesarean delivery for women with two or more previous uterine scar. However, we continue to see patients with two or more previous scars undergoing emergency caesarean section. There is no documentation of proportion and associated factors of pregnant women with two or more prior CS come for delivery while in labour and how it contributes towards increased maternal and perinatal mortality in Mwanza, Tanzania.

Objective: To determine the proportion and associated factors among pregnant women coming while in labor with two or more previous cesarean sections Mwanza region-Tanzania.

Methods: This study was a cross sectional hospital-based study, involving 275 pregnant women underwent cesarean due to two or more prior cesarean section in the maternity wards and postnatal wards of Bugando medical center (BMC), Sekou Toure Regional Referral Hospital (SRRH), Nyamagana District Hospital (NDH) and Sengerema Designated District Hospital (SDDH). Data analysis was done by using STATA version 13 according to objectives.

Results: Total numbers of 275 pregnant women with more than one prior cesarean section scar were enrolled in this study from four selected hospitals in Mwanza. Their median age was 30(IQR 25-33). Most of them, 124 (45.1%) were from Bugando Medical Centre followed with Sengerema Designated District Hospital, 82 (29.8%). Of note, all 275 (100.0%) pregnant women with more than one previous uterine scar attended ANC and majority, 171 (62.2%) had four or more visits. 183(66.6%) participants presented with labor pain and they underwent emergency CS, there were 9 (3.3%) perinatal deaths, 30(10.9%) of new born resuscitation was required whereas 36(13.1%) had postpartum hemorrhage, ruptured uterus 9(3.3%). In multivariate logistic regression, associated factors for pregnant women with more than one previous cesarean scar coming while in labor were attending antenatal care clinic last visit in dispensary and Health centre (OR 5.0[95% CI 1.0 – 24.5], p-value=0.046), unemployed (OR 13.2[95% CI 2.4 – 71.9], p-value <0.001), visiting antenatal clinic less than four visit (OR 5.5[1.9 – 16.1], p-value=0.002) and cadre of Health provider attending her in last antenatal visits (OR 18.8[5.3 – 66.7], p-value <0.001) were significant (P-value<0.005).

Conclusion: 66.6% proportion of pregnant women with more than one prior CS coming in labour need special attention as a measure of reducing maternal and perinatal morbidity and mortality in Mwanza region and need of informed/counselled them during antenatal visits where and when to deliver by Caesarean section . Only 33.4% of pregnant women with two and above previous scar had elective CS while was supposed to be 100% in order to reduce Maternal mortality rate at least 80%.

Recommendations: Pregnant women with more than one prior caesarean section scars when attend in primary health care facility in their antenatal clinic visit which cannot perform surgery should be counselled and referred to a high health facility with operated theatre and be seen with a health care provider who can decide when to deliver and plan the date for caesarean section.

• There is a need for regular on job training for non-physician health care providers attending pregnant women with more than one prior caesarean section in the dispensary and health centre to know the importance of identifying of obstetric danger signs by following Reproductive Child Health (RCH no.4) guideline specifically to uterine scars complication and counselling pregnant women with more than one prior caesarean scar where, when and mode of delivery before labour pain start.

• High attention and special emphasis should be given to pregnant women with more than one prior caesarean section scar who was unemployed and having less ANC visits on for close caring and monitoring for their newborn after caesarean section

ER  -