Prevalence and predictors of obstetric outcomes among women with multiple Caesarean Sections at Iringa Regional Referral Hospital, Tanzania

Introduction: Multiple Caesarean Sections (CS) are associated with an increased risk of adverse obstetric outcomes. Data on predictors are scarce. The objective of this study is to determine the prevalence and predictors of obstetric outcomes among women with multiple CS.Method: This analytical cross-sectional study was conducted at Iringa Regional Referral Hospital and included 215 women with multiple CS. The purposeful sampling technique was used to recruit participants in the maternity ward. Data were collected using a structured questionnaire and analysed by SPSS version 26. Descriptive statistics were used to analyse categorical data using frequency and percentages, whereas continuous data were analysed using the median with an interquartile range. Chi squared tests and binarylogistic regression, both univariate and multivariate, were used to access the association between variables, and a p value <0.05 was considered statistically significant.Results: The median age was 32 with 6 years inter quartile range (IQR). The prevalence of adverse outcomes was 31.6% for maternal and 24.2% for foetal outcomes. Adverse maternal outcomes were: post-partum haemorrhage (PPH) 61 (28.4%), hysterectomy 20 (9.3%), and bladder injury 12 (5.6%), uterus rupture 5 (2,3%). Adverse foetal outcomes were: low Apgar score 49 (22.2%), prematurity 28 (13%) and neonatal death 7 (3.2%). Predictors of adverse maternal outcomes: lack of third trimester ultrasound [p value= 0.004, OR=4.66, 95% CI (1.66-13.14)], emergency CS [p value<0.001, OR=34.4, 95% CI (7.9-151.1)] and delay one (failure to recognise there is a problem requiring transfer to hospital) [p value<0.001, OR= 6.57, 95% CI (2.50-17.31)]. Foetal outcomes: preterm deliveries [p value<0.017, OR=3.63, 95% CI (1.26-10.48)], lack of ultrasound checkup [p value=0.002, OR=3.92, 95% CI (1.68-9.14)] and first delay [p value<0.001, OR=4.84, 95% CI (2.04-11.48)].Conclusion: The prevalence of adverse outcomes among women with multiple CS deliveries is high in our setting. Third trimester ultrasound is important in detecting risks of adverse obstetric outcomes.