Primary caesarean section: trend, predictors and outcomes among low risk multiparous women at tertiary hospital northern Tanzania: a cross sectional study

Abstract Background: Cesarean section rate has been increasing worldwide, surpassing the standard cesarean section rate set by WHO of 10-15%. Primary cesarean section has been a major contributor to the overall Cesarean section rates. Studies have reported much on primary caesarean section on prime parous however the prevalence, risk factors and outcomes of caesarean section in multiparous women who had previous vaginal birth are still understudied. Therefore, the study aimed to determine the trend and predictors, and outcome of primary cesarean section in low-risk multiparous women. Method: We conducted a cross-sectional study using birth registry linked data from Kilimanjaro Christian medical center from 2012 to 2021. Multiparous women who delivered from 37 to 42 weeks were enrolled in the study after exclusion of those with medical and obstetric risk condition. Social demographic and obstetric characteristics were used to determine the predictors of caesarean section by using multivariate logistic regression. Maternal and neonatal outcome were computed using chi squire. Results: Total of 12760 multiparous women were enrolled for analysis, the overall prevalence of primary CS of 36.8%, the indications reported were fetal distress, malposition and labor dystocia. During the study period the trend has been constantly high, with its peak prevalence of 41.0%, there was a gradual decline of prevalence to 22.4% from 2019 to 2021. Advanced maternal age >35 years and obesity were independent predictors of primary caesarean section (AOR 1.15, 95%CI 1.06-1.26, AOR1.40 95%CI 1.09-1.80). Maternal and neonatal outcomes associated with primary CS were postpartum hemorrhage, blood transfusion and Apgar score of >7 in first minute. Conclusion: The trend of CS was high and factors contributing to CS were maternal obesity and advance maternal age. Pre conceptual counseling to women in communities and antenatal clinics on health education on diet and lifestyle modification are key in reducing the burden of obesity.