Definition of term: Caesarian sections means a surgical procedure where one or more incisions are made through a mothers abdomen and uterus to delivery one or more babies.
Background: Caesarean has been recorded in history since times in both western and non-western literature. Although the first use of the term in obstetrics was from the seventeenth century, the origin of the term caesarean section in believed to be from the birth of Julius Caesar. In ancient times, it was performed only when the woman was dead or dying as an attempt to rescue the fetus and this was done until the era of anesthesia in the nineteenth century. Development in surgical technique from later nineteenth century and through the consequence, the objectives of caesarean section have evolved of mother and child as well as considering the mother’s preferences. In the early modern they discovered some anesthesia like Ether and Chloroform but chloroform become popular for pain relief and became a practical means of anesthesia in cases of caesarean section because was inducing a state of unconsciousness. 1870s it was generally believed that suturing the uterine was not necessary because no sutures are required in the uterus; as it contracts, the wound will be reduced to 1-2 inches and lips will come into opposition. But in 1876 they did hysterectomy during caesarean section to control uterine hemorrhage and peritonitis and this was able to reduce maternal mortality but cost of the woman’s future fertility and this method showing maternal mortality of 58% and fetal survival 85%, a major improvement and later they developed suturing material made of silver wire. In 1926 they began operating transperitoneally and retrovesically using longitudinal incision in an operation and later introduce transverse incision which become preferred to the longitudinal incision because of low hemorrhage and reduced of rupture during subsequent of vaginal delivery. (1) There are several technique of caesarean section which are; the Joel-Cohen method for opening the abdomen, suturing the uterus in one layer and non-closure of the visceral and parietal peritoneal layers and Pfannestiel incision in which the incision in made transverse suprapubic and uterus is sutured in two layers and both peritoneal layers and sutured. The incidence of postoperative febrile morbidity was 7.7% for Joel-Cohen compared with 19.8% for Pfannestiel incision; and adhesion were found in 6.3% reported operation after Joel-Cohen compared with 28.8% of Pfannestiel incision. (2)
Another technique is modified lower segment caesarean section (LSCS) or is called Misgavl Ladach method is done by opening the mother’s abdomen through the lower midline incision then you cut just above the edge of the bladder by making transverse incision in the uterus, this method reduces operation time, time of child delivery and time of recovery. (3)
Furthermore, the study compared two groups of patients who were performed with different technique and find better postoperative result in patients that were treated with lower segment caesarean section compared with a tradition method (Pfannestiel incision) and the result were graded on the intensity of pain, presence of neuropathic, chronic pain and the cosmetic appearance of the scar. (4)
The rate of caesarean section has significantly dropped between the time periods 1980-1990 in four countries (Sweden, Scotland, and United State) and the main indication were fetal distress, previous caesarean section, breech presentation and dystocia. (5)
Also three quarters of women from hospitals of Sub-Saharan Africa were delivery by caesarean section and this has been rise since 1970 and the main indications were protracted labour, abruption placenta, previous caesarean section, eclampsia, placenta previa and malpresentation. (6)
Furthermore, caesarean section has fetal maternal outcome where by the risk of placenta accrete, cystotomy, bowel injury, ureteral injury and ileus, the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and hospital stay significantly increased with increasing number of caesarean section deliveries. (7)
Objectives. General objective: The pattern of caesarean section at Bukoba region hospital.
Specific objectives: To know the indication of caesarean section at Bukoba region hospital. To know the social demographic characteristics of patient who had caesarean section at Bukoba region hospital. To know the duration of hospital, stay of patient post caesarean section at Bukoba region hospital. To know caesarean section rate at Bukoba region hospital. To know fetal-maternal outcome of caesarean section at Bukoba region hospital.
Field attachment duty plan: The period of attachment will be 4 weeks, during period I will participate in the following things. Participating in the ward services and major ward round. Participate in the caesarean section deliveries. Participating on follow up post caesarean section patient. Participating in postoperative care. Attending morning report. Participating in spontaneous vaginal delivery (SVD). Participating in admitting patient in the labour ward. Participating in the management of the progress of labour by using patograophy.
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