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Prolonged labour as a driver of the ”caesarean section pandemic”: A criterion-based audit of caesarean sections in the five highest volume maternity units in Dar es Salaam, Tanzania
  • +13
  • Monica Lauridsen Kujabi,
  • Natasha Housseine,
  • Sarah Hansen,
  • Brenda Sequeira D’mello,
  • Dan Meyrowitsch,
  • Flemming Konradsen,
  • Andreas Kryger Jensen,
  • Hussein Kidanto,
  • nanna maaloe,
  • Thomas van den Akker,
  • Idrissa Kabanda,
  • Rukia Juma Msumi,
  • Luzango Maembe,
  • Sangalala Mtingele,
  • Hudson Manyanga,
  • Anna Macha
Monica Lauridsen Kujabi
Aarhus Universitetshospital

Corresponding Author:[email protected]

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Natasha Housseine
Kobenhavns Universitet Globe Institute
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Sarah Hansen
Aarhus Universitet
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Brenda Sequeira D’mello
Kobenhavns Universitet Globe Institute
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Dan Meyrowitsch
Kobenhavns Universitet Globe Institute
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Flemming Konradsen
Kobenhavns Universitet Globe Institute
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Andreas Kryger Jensen
Kobenhavns Universitet Globe Institute
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Hussein Kidanto
The Aga Khan University School of Nursing and Midwifery East Africa Dar es Salaam
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nanna maaloe
Kobenhavns Universitet Globe Institute
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Thomas van den Akker
Vrije Universiteit Amsterdam Athena Instituut
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Idrissa Kabanda
The Aga Khan University - Tanzania Dar es Salaam, TZ
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Rukia Juma Msumi
The Aga Khan University - Tanzania Dar es Salaam, TZ
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Luzango Maembe
United Republic of Tanzania Ministry of Health Dar es Salaam, TZ
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Sangalala Mtingele
United Republic of Tanzania Ministry of Health Dar es Salaam, TZ
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Hudson Manyanga
United Republic of Tanzania Ministry of Health Dar es Salaam, TZ
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Anna Macha
The Aga Khan University School of Nursing and Midwifery East Africa Dar es Salaam Dar es Salaam, TZ
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Abstract

Objective: To estimate the proportion of caesarean sections (CS) not meeting audit criteria for prolonged labour. Design: Cross-sectional. Setting: Five urban maternity units in Dar es Salaam, Tanzania. Population: Women giving birth by CS with an indication of prolonged labour, from October 1 st, 2021 to August 31 st, 2022. Exclusion criteria: referral to the study sites because of prolonged labour or cervical dilatation >6 cm upon admission; non-cephalic presentation; multiple pregnancy; intrauterine fetal death; failed induction; previous CS; or other reasons for CS. Methods: Criterion-based audit of CS case files with an indication of prolonged labour. Main Outcome Measure : CSs in women with uncomplicated labour progress. Results: Overall CS rate was 32% (2949/9364) and 746/1517 (47.9%) of first-time CSs were performed because of prolonged labour. Out of these, 456 met inclusion criteria and 243/456 (53.3%) CSs were in uncomplicated labour: 1) women not being given a trial of labour (78/243, 32.1%); 2) women in first stage of active labour not crossing the partograph action line (145/243, 59.7%); and 3) women in second stage less than 1 hour (20/243 8.2%). Conclusion: Almost half of CS in the unscarred uterus were because of prolonged labour and many did not meet audit criteria for prolonged labour. Crowded hospitals and inadequate monitoring may have prompted defensive decision-making. Unconducive labour wards may, therefore, indirectly drive the CS epidemic while clinical guidelines for CS decision-making remain scarce.