Audit for diagnosis of indications for caesarean section among women of low risk group at a tertiary hospital in Tanzania.

Abstract

ABSTRACT Background: Caesarean section (CS) rate is dramatically increasing in both developed and developing countries across obstetric populations even those with minimal risk receive it. The group of multiparous women with singleton pregnancy in cephalic presentation at term in spontaneous labour, without history of previous CS has low risk for CS but yet high rate of CS has been reported. The aim of this study is to audit for diagnosis of common indications for CS against the criteria for standard diagnosis of indication for CS among women of low risk group. Methodology: A descriptive cross-sectional study was conducted at Muhimbili National Hospital from 15th August to 31st December 2018. The common indication for CS among women of low risk group were fetal distress, obstructed labour, arrested labour and cephalopelvic disproportion. The criteria for standard diagnosis of these indications for CS were adapted from International, National guidelines and peer groups publications based on local expert consensus. The information was extracted from case notes and partographs against the checklist for indications for CS and adapted criteria for standard diagnosis of obstructed labour, fetal distress, arrested labour and cephalopelvic disproportion. The proportions for indications for CS and standard diagnosis were analysed through composite scoring using SPSS version 20. Results: A total of 1670 emergency CS performed during the study period, 392 (23.5%) were among the women of low risk obstetric characteristics for CS. Fetal distress 101(25.8%), obstructed labour 92(23.5%), arrested labour 88(22.4%) and cephalopelvic disproportion 64(16.4%). Among the four indications for CS 55.1% meet the criteria for standard diagnosis for indications for CS. Conclusion: More than half of CS performed during the study period had meet the criteria for the standard diagnosis of fetal distress, obstructed labour, arrested labour and CPD. Recommendations: More studies to determine the factor hindering the adherence of the criteria for standard practice among health care providers during clinical practice.