Journal of Clinical Oncology & Advanced Therapy

Abstract

Background: Caesarean section (CS) is a critical surgical procedure that can save lives, but its access varies significantly between geographical locations, leading to disparities in maternal outcomes. In Tanzania, one strategy to address this has been the upgrade of selected health centres to provide Comprehensive Emergency Obstetric and Neonatal Care (CEmONC), aiming to improve the availability and quality of life-saving procedures, including CS. However, detailed information on the extent to which CS is performed, its indications, and outcomes in these upgraded health centres remains scarce. This study provides essential data on these parameters, aiming to inform policy and guide the optimization of obstetric care standards by addressing critical knowledge gaps related to caesarean section practice

The Study Aimed: To determine the proportion, indications, and immediate outcomes of caesarean sections at the upgraded health centres in Temeke Municipality.

Methods: A descriptive cross-sectional study analysed 432 medical files of women who gave birth at Maji Matitu, Yombo Vituka, and Mbagala Round Table upgraded health centres in Temeke Municipality from 1st January 2021 to 31st December 2022. A structured checklist was used to extract information regarding indications and fetal-maternal outcomes of CS from medical records. The data were analysed using descriptive statistics in the Statistical Package for the Social Sciences (SPSS), version 23.0, to summarize the proportions, indications, and immediate outcomes associated with caesarean delivery.

Results: The mean age of the pregnant women was 26 (SD±5.6) with majority (92%) falling between 18 to 35 years with 79% of being para 1 to 3. Regarding antenatal care, 76% of women made 4 to 8 visits and 43% were anaemic at the time to the CS. Most new-born (87%) were delivered at term. The overall proportion of CS at the upgraded health centres was 21%. The primary indications CS included fetal distress (23%), Robson Group 1 (47%), previous CS scar (19.8%), and cephalopelvic disproportion (11%). Almost all women had live birth and 98% stayed in the facility for 3 days post-operation. However, 5.4% of the new-borns were refereed for Neonatal Intensive Care Unit (NICU) admission.

Conclusion: This study reveals a high CS rate in upgraded health centres, primarily due to fetal distress, previous CS scar, and cephalopelvic disproportion. Most CS procedures were on low-risk women, while maternal and fetal outcomes were generally good, further research is needed to address these high rates in low-risk women and improve neonatal care.