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How rational are indications for emergency caesarean section in a tertiary hospital in Tanzania?

Mdegela, Mselenge H., Muganyizi, Projestine S., Pembe, Andrea B., Simba, Daudi O. and van Roosmalen, Jos (2012) How rational are indications for emergency caesarean section in a tertiary hospital in Tanzania? Tanzania Journal of Health Research, 14 (4). pp. 236-242. ISSN 1821-6404

Item Type: Article

Abstract

The rate of caesarean section (CS) at Muhimbili National Hospital (MNH) in Tanzania has been on progressive increase for past three decades. Concerns have been raised if this increase is justified by rational decisions but no study so far has investigated this problem. The aim of the study was to find out whether decisions made for CS comply with a set of locally made standards, with an assumption that if the standards are met, then the increase in CS rate seen at MNH is genuine. The five most common indications for CS were identified from the obstetric electronic data base. Most common indications included obstructed labour, cephalopelvic disproportion (CPD), failure to progress, repeat CS and foetal distress. Criteria for the best practice for each indication were developed based on the National guidelines and local expert consensus. Information extracted from the case notes, antenatal cards and partographs were
compared to the standard audit criteria and the decision judged as standard or substandard. Three hundred forty five women had a decision made for emergency CS. Repeat CS was the most frequent indication (30.2%), followed by obstructed labour (14.4%) and foetal distress (13.6%). Audit of 324 women’s files showed that 30% of women had substandard decisions for CS mostly in the foetal distress group (59.1%) and least in the repeat CS group (9.1%). Among the 324 mothers with decision for emergency CS, 279
(86.1%) delivered by CS as decided and 45 (13.9%) delivered vaginally before CS could be performed. Women who delivered vaginally after decision for CS and the nulliparous women had significantly more substandard decisions compared to those delivered by CS and parous women respectively. In conclusion, a substantial proportion of decisions for emergency CS made in the hospital is substandard and may contain women in whom surgical intervention could be avoided. This calls for a need to improve quality of assessment and decision before performing CS.

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More Information

Uncontrolled Keywords: decision, criterion-based audit, obstetric care, caesarean section, delivery, Tanzania
Depositing User: Mselenge Mdegela

Identifiers

Item ID: 15976
Identification Number: https://doi.org/10.4314/thrb.v14i4.1
ISSN: 1821-6404
URI: http://sure.sunderland.ac.uk/id/eprint/15976
Official URL: https://doi.org/10.4314/thrb.v14i4.1

Users with ORCIDS

ORCID for Mselenge H. Mdegela: ORCID iD orcid.org/0000-0002-0374-6583
ORCID for Projestine S. Muganyizi: ORCID iD orcid.org/0000-0002-8362-2408
ORCID for Andrea B. Pembe: ORCID iD orcid.org/0000-0002-8090-3298
ORCID for Daudi O. Simba: ORCID iD orcid.org/0000-0002-6158-5562
ORCID for Jos van Roosmalen: ORCID iD orcid.org/0000-0002-6746-3259

Catalogue record

Date Deposited: 11 May 2023 11:48
Last Modified: 11 May 2023 11:48

Contributors

Author: Mselenge H. Mdegela ORCID iD
Author: Projestine S. Muganyizi ORCID iD
Author: Andrea B. Pembe ORCID iD
Author: Daudi O. Simba ORCID iD
Author: Jos van Roosmalen ORCID iD

University Divisions

Faculty of Health Sciences and Wellbeing > School of Psychology

Subjects

Sciences > Health Sciences

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