Caesarean rate and uterine rupture: a 15-year hospital-based observational retrospective study in rural Tanzania.
BACKGROUND
The population-based Caesarean rate in sub-Saharan Africa is very low. The lack of necessary Caesarean sections is an important cause of the high maternal mortality and morbidity in sub-Saharan Africa. The Nyakahanga District Hospital in Western Tanzania showed a persistent and massive increase in the Caesarean rate which was induced by the Rwandan refugee crisis of 1994-1996. We thus examined the question: Is the doubling of the hospital-based Caesarean rate in a rural district hospital in sub-Saharan Africa associated with a change of maternal mortality and morbidity?


METHODS
All deliveries at the Nyakahanga District Hospital from 1985 to 1999 were included. The study period was divided into the period before and that after the refugee crisis. Caesarean rate, overall uterine rupture, uterine rupture after Caesarean section, maternal death, and stillbirth of both periods were compared.


RESULTS
The mean Caesarean rate increased from 9.4 % in the pre-refugee period to 20.3 % in the post-refugee period. The doubling of the Caesarean rate has been associated with an increase of the rate of uterine rupture from 4.4 to 13.5 per 1 000 deliveries [odds ratio 3.08 (95 % CI 1.97-4.81)]. Uterine rupture associated with previous Caesarean section increased even more [OR 6.3 (1.77-22.42)]. Maternal mortality [OR 1.17 (0.83-1.66)] and stillbirth [OR 0.96 (0.77-1.19)] rates did not change.


CONCLUSIONS
The increasing Caesarean rates in rural sub-Saharan Africa might impose an additional hazard of increasing rates of uterine rupture without reducing the rates of maternal mortality and stillbirths.
Stein
W
W
Department of Gynecology and Obstetrics, Georg-August-University, Göttingen, Germany. werner.stein@med.uni-goettingen.de
Katundo
I
I
Byengonzi
B
B
D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D050497:Stillbirth / Q000453:epidemiology*; D013636:Tanzania / Q000453:epidemiology; D014597:Uterine Rupture / Q000401:mortality* / Q000517:prevention & control*; D055815:Young Adult