MBEYA COLLEGE OF HEALTH

AND ALLIED SCIENCE

DEPARTMENT OF CLINICAL
MEDICINE
Student Name: ALISON P HENGEKA
Nacte Reg:NS0138/0003/2019
 RESEARCH TITLE

RISK FACTOR AND CAUSES OF

CAESAREAN SECTION AMONG WOMEN
DELIVERED AT IGAWILO CITY HOSPITAL
 INTRODUCTION

• Caesarean section is the delivery of the fetus, placenta, and membrane through an
abdominal and uterine incision. It may be performed of the maternal or fetal
problems, obstetric or medical conditions, either maternal request or choice. When
it’s necessary, it can be more a life saving techniques for both mother and baby.
• The first modern caesarean section was performed by Dr James Barry in cape town,
south Africa on 25th July 1826 (cronjé, 2012).
• Maternal complication of caesarean sections can be injury to the organ, hemorrhage ,
infections, wound complications, anesthesia hazard, intestinal obstructions shock and
eventually death due to shock.(dutta’s2015). And baby is RDS, jaundiced,
hypoglycemia, and development problem like slow learning
 RESEARCH OBJECTIVES
General Objectives
• To identify the risk factor and causes contributing to the caesarean section of
pregnant women delivered at Igawilo city hospital.
Specific Objectives
1. To identify the obstetric causes contributed to caesarean section delivered of
pregnant women at Igawilo city hospital.
2. To determine the social-cultural practice related to caesarean section delivered
of pregnant women at Igawilo city hospital.
3. To identify the nutrition status of pregnant women related to caesarean section
at Igawilo city hospital.
 RESEACH METHODOLOGY

Study Area
 The study was conducted at Igawilo city hospital involving maternity department (labor ward
and post-natal ward). This hospital is among of the city hospital of Mbeya regions located
southern highland of Tanzania nearby Uyole road to Kyela, Whereby the majority of the people
living in this place are Nyakyusa by tribe and main activities was found to be maize agriculture
during cold conditions as a main weather conditions and much of them are doing a small venture.

Study Design
 The study used was Quantitative approach employing analytical cross-sectional design. This is
the best design to determine prevalence and establishing associations between predictor and
outcome variables
 Study Populations
 The study was involved all delivered pregnant women at Igawilo city hospital who admitted
at post-natal ward.
Selections Criteria
Inclusions Criteria
 All women who was delivered and admitted at postnatal ward.
Exclusion Criteria
 Women who was very sick and mothers who lose their babies, psychological mothers,(baby –
born before arrival) and home delivery.
Sampling Procedure
 Randomly sampling was employed to select a sample to the women who was at post-natal ward.
Sample Size Determinations
• Formula: n=
• Where n = desired sample size
• Z2=1.96 confidence interval of the study populations at 95%
• P=prevalence of the c/s among pregnant women at Igawilo city hospital 9%
• d2 =marginal of error at the 5%
• = (1.96)2 x9(100-9)
• (5%)2
• = 125.85 ~126
 Data Collection Techniques / Tools
The data was collected through review of document (patient files) and Administered Questionnaire
techniques. The tools that used to collect the information was a paper, pen, note book and questionnaires
questions.
Data Processing and Analysis
Data obtained from this research study was manually calculated using scientific calculator and entered
into excel - worksheet where data was being processed and analyzed. Descriptive statistics was carried out
to measure incidence rates and relative risk of the variables involved during the study by using personal
chi-square (x2)
Dissemination of Results
Final results of the study would be submitted at MCHAS ,department of clinical medicine. It would be
then disseminated to Igawilo city hospital and finally presented to the department of clinical medicine.
Ethical Considerations
I was seeking the ethical approval from MCHAS research ethic and review committee for permission to
conduct this research and Prior on providing questionnaire to respondents I was seeking informed consent.
 RESEARCH FINDING
SOCIO-DEMOGRAPHIC CHARACTERISTIC OF PARTICIPANT
 The majority of respondents 90 (71.2%) aged between 18 and 28, About 50 (39.69%) had
primary educations with 60 (47.62%) of secondary education, and 76 (60.32%) were peasant
with 34 (26.98) of petty business, majority of mothers 112(88.89%) were married. Also, majority
of mothers about 106 (86.5%) came direct from home (self-referral) and few about 17 (13.5%)
were referred from dispensary. On payment category majority of mothers about 106(84.13%)
were using user fee and few of them about 12(9.52%) were using NHIF.
BIVARIATE ANALYSIS OF NON OBSTETRIC FACTOR
 The results show that non obstetric factors which are statistically significant are; cash payment
category (χ2 = 14.002, df = 2, P < 0.0001) and women who have primary and secondary
educations (χ2 = 26.197, df = 3, P < 0.0001)
 The other factors were not statistically significant such as; time of delivery (χ2 =3.613, df = 1, P
>0.05), day of delivery (χ2 = 0.124, df =1, P > 0.05), economic status of mother (χ2 = 0.457, df
=3, P > 0.05) and economic status of the mother (χ2 = 0.457, df =3, P > 0.05)
 OBSTETRIC FACTOR OF PARTICIPANT
 Obstetric factor associated with cs was height above 150cm compared to below it,parity of 1 up 3
pregnancy where by majority delivered at GA of 37 up 42 with a single newborn. And mostly of
newborn delivered were have weight of 2.5kg and above with also APGAR score of 7 up 10.
 However, based on the underlying co-morbidity medical conditions prior to delivery 106(84.13%)
had no co-morbidity conditions while 16(12.7%) had pregnancy induced hypertensions (PIH), 4(3.17)
had pre-eclampsia or eclampsia, with no any case of genital warts, Diabetic mellitus and HIV/AIDS.
BIVARIATE ANALYSIS OF OBSTETRIC FACTOR AND C/S
 The results show that the increase of caesarean section rate is associated with obstetric factors, the
factors which are statistical significant are; extreme maternal height below 150cm(χ2 = 26.415, df =
2, P < 0.05), extreme birth weight of below 2.5 kg and above 4.0 kg (χ2 = 12.172, df = 1, P < 0.001),
APGAR score of newborn at 0 to <7 (χ2 =5.070,df =1,p <0.05), CO-morbidity medical conditions
such as PIH, pre-eclampsia, eclampsia and maternal infections, DM, HIV/AIDS (χ2 = 43.92,df =3 P
< 0.0001) and increase number ANC elective CS (χ2 = 9.792, df = 2, P < 0.001).
 Obstetric factors which were not statistically significant at a different chi-square, degree of freedom and cut
point of p <0.05 was a maternal age, parity of mother, gestation age and number foetuses delivered
 The rate of caesarean section among 126 postnatal mothers was 49 (38.89%).To which emergency were
accounted for 108 (85.71%) while 18 (14.29%) were elective caesarean section. The about 43(87.76%)
primary and whereby about 6 (12.24%) were repeated Cs.
 The leading indications were previous scar 13(20.97%), non-reassurance fetal distress 12 (19.35%),
malpresentations 12(19.35%), prolonged /obstructed labour 10(16.13) and big baby 05(8.06%).
FACTOR INFLUENCING MODE OF DELIVERY
 The factor which influenced women to prefer caesarean section delivery are; high intake of fat (low
carbohydrate/ loss of energy 25(19.84%), intact vaginal 31(24.60%), pregnancy complications59(46.83%),
prior CS delivery 6 (4.76%) and having history of Intra Uterine Foetal Death (IUFD) 7 (5.56%). Individual
influence was 62(49.21%) and about 51(40.48%) health care provider and few them partner, relatives and
friends.
 Participants had reported several factors which influences increase of caesarean section deliveries such as
Reassurance to getting a live baby 9(7.14%) ,No labour pain 3(2.38%), Cs prevent unnecessary neonatal
death 7(5.56), fear of labour pain / vaginal birth 05 (3.97%), desire for their vaginal to remain intact 09
(7.14%), desire for the baby with high IQ 02(1.9%), lack of exercise and laziness during pregnancy 12
(29.52%), health problems during pregnancy 24 (19.05%), prevention of neonatal death during delivery
09 (7.14%), Use of herbs 1 (0.79), use of contraceptives 09(7.14%), teenage pregnancy 11(42.31%),
prevention of transmission of infection to neonates 2(1.59%), obesity 10(7.94%), influence of Health Care
Provider 6 (4.76%), Fear of losing the babies 4 (3.17%) and desire to deliver few babies 6 (4.76%).
 And Mostly of women perceive SVD 107 (84.92%) and Cs 19 (15.08%)
 RESEARCH RESULT DISCUSSION
Obstetric factors associated with caesarean section deliveries were as follows;
 The results revealed that rate of caesarean section increases with height of mother below 150cm. this because the
mother of below 150cm have not enough developed pelvic brim compared to mother with above 150cm , to
accommodate the foetus passage during labour thus prefer a Cs as a safe mode of delivery By which is similar to study
(Yoshioka-Maeda et al., 2016) which showed that mothers with height below 150 cm are at risk of caesarean section
deliveries.
 Another, obstetric factor is birth weight; findings showed that the rate of caesarean section increases with increase
extreme birth weight (below 2.5 kg and above 4.0 kg) with the rate of 66.67% compared to normal of 13.33% (2.4 kg
to 4.0 kg).This study is related to the study conducted in Oman by (Busaidi et al., 2012 and Olusanya et al., 2016))
which shows that extremes of neonatal birth weight (<2.50 kg and ≥4.00 kg) is positives associated with the risk of
caesarean delivery.
 Moreover, co-morbid illness is associated with high risks of caesarean deliveries such pregnancy Induced Hypertension
(PIH) 87.5%, pre-eclampsia / eclampsia 75%, maternal infections 75%.The co morbid illness was almost 93.88 %
whereby both were under medical indications; the co-morbid illness has been associated with pregnancy and labour
complications which increases the risks of caesarean deliveries.
 Furthermore, the results show that increase of caesarean section rate is associated with increased number of ante natal
visits (P < 0.001), the higher rate was elective caesarean section as compared to emergency caesarean section (P <
0.001).
Indications of caesarean section deliveries were as follows;
 Majority of caesarean section conducted were emergency and accounted for 108 (85.71%) while elective caesarean
sections were 18(14.29%). This study is similar to the study conducted at MNH, which revealed that majority of
caesarean section deliveries were by emergency cs (Mdegela et al., 2012). This explain that 46(93.88%) was under
medical indication while 3(6.12%) were under another maternal factor, as was medically justified.
 The leading indications under this study were previous scar 13(20.97%), non-reassurance fetal distress 12 (19.35%),
malpresentations 12(19.35%), prolonged /obstructed labour 10(16.13) and big baby 05(8.06%), cephalon-pelvic
disproportional 03(4.84%), PIH 03(4.84%), Pre-eclampsia 02(3.23%) and bad obstetric history 01(1.61%)
 The non-obstetric factors associated with caesarean deliveries include the following;
 Socio economic status which is explained by category of payment and occupation revealed that the rate of caesarean
section is higher among women with high socio-economic status as Cash payment category reveal to have a high rate
compared to other. This can be compared with Tanzania Demographic and Health Survey, 2016 which shows that
women with high socio-economic status are eight times likely to delivery by caesarean section.
 It also observed that the rate of caesarean section is more among mother who have primary and secondary educations.
This can explain that educations help the mother to decide what a good method of delivery.
 However, others social factor (maternal request) and preference of the mother were considered to be associated. The
study reveals that very few women about 3 (6.12%) delivered by caesarean section due to social and person factor as
well as very few preferred 9(7.14%) caesarean section delivery. This is similar to the study conducted in Italy and
Tanzania in Dar es salaam(Litorp, 2015) which shows that about 6.4% was preferred caesarean delivery while majority
preferred vaginal birth (Gamble, Health, & Creedy, 2001).
 Among few women who preferred caesarean deliveries they are influenced by the factor of , high intake of
fat (low carbohydrate/ loss of energy 25(19.84%), intact vaginal 31(24.60%), pregnancy
complications59(46.83%), prior CS delivery 6 (4.76%) and having history of Intra Uterine Foetal Death
(IUFD) 7 (5.56%).
 These factors associated with caesarean delivery was supported by the study by (Storksen et al., 2001 and
Oguta,2015 psychological determinant) which reveals that fear of vaginal birth and previous birth experience
contributes to caesarean delivery. Also, other explored factors were desire for their vaginal to remain intact
(sexual practices), desire for the baby with high IQ, lack of exercise and laziness during pregnancy, Health
problems during pregnancy, Prevention of neonatal death during delivery, use of herbs, use of contraceptives,
teenage pregnancy, Prevention of transmission of infection and diseases to infant during delivery, Obesity,
Influence of Health Care Provider, fear of losing the babies. The factors reported by women are due to their
previous birth experience, interpersonal and social influence and perception of caesarean delivery with the
community.
 Moreover, few women about 19 (15.08%) perceived caesarean section as safe mode of delivery. The reason
for their perception is related to their previous birth experience such as; reassurance of getting a live baby
and prevention of unnecessary neonate death.
 RECOMENDATIONS
Ministry of Health, may incorporate the Midwives Model of Care in Reproductive and
Child Health (ANC and Post-partum care) services which focuses holistically on the well-
being of the mother throughout the pregnancy and postpartum as emphasis natural birth
and reduces the number of high-risk pregnancies and the need for caesarean section.
Ministry of Health, may consider strengthening family planning services to increase
coverage and emphasis on youth friendly reproductive health services; this will teenage
pregnancy, neonatal morbidity and mortality and hence reduce caesarean section
deliveries.
Ministry of Health, Training department should advocate to incorporated midwifery care
model in medical and nursing training at all levels to ensure students are well prepared to
provide holistic care to pregnant women.
Igawilo city hospital should develop and operationalize guideline for safe conduct of
vaginal birth after caesarean section as leading indication for CS is previous scar.
Igawilo city hospital management should consider regular coaching of staff on
appropriate Foetal monitoring.
Health Care Provider (Midwives and Doctors) should provide psychological support to
women throughout pregnancy until delivery and emphasis on natural birth
 CONCLUSIONS
The rate of caesarean section at Igawilo city hospital is relatively high. There is the need
to reduce to the reasonable/optimum rate; this can be achieved by reducing unnecessary
cesarean deliveries among women with low risks. Health care providers should be
aware of the risks of unnecessary caesarean section as well as women should be fully
informed on benefits and risks of caesarean section.