Obstetric outcome among women with one previous caesarean section at Muhimbili National Hospital, Dar es Salaam, Tanzania

Abstract

Objective: To determine obstetric outcome among women with one previous caesarean

section (CS).

Methodology: A hospital based cross sectional descriptive study was conducted

frOml3th September 2006 to 2"d February 2007 at Muhimbili National Hospital, Dar-es-

salaam, Tanzania. All women with one previous CS coming for delivery were identified

on admission. Data on demographic, obstetric, social and medical history, the outcome of

the index pregnancy and the indication for the previous CS were collected. The maternal

and perinatal outcomes of patient who underwent trial of scar (TOS), elective repeat CS

(ERCS) and emergence repeat CS (EmRCS) were analysed.

Main results: There were 3,285 deliveries conducted during the study period of which

365 (ll .I%) had one previous CS. TOS was done in 80 (22.3%) women of which

41(51.2%) had successful TOS. Dystocia accounted for 63% of the failed TOS and was

the main indication for repeat CS (43.5%). It also contributed to 62.6% of the indication

for the first CS. There was no much difference in foetal outcome between women

underwent TOS and those repeat CS was done. ERCS resulted in better APGAR score

than ERCS. There were seven ruptured uterus all in EmRCS. The mean decision time for

failed TOS to delivery was 3 hours and the mean duration of labour was 9 hours.

Conclusion: The proportion of women undergoing TOS is small. The success rate in

TOS is more than 50%~ There was no much difference in morbidity between women

underwent TOS and those repeat CS was done. Doctors should be encouraged to offer

TOS to pregnant women with one previous caesarean section.