title: The effects of previous cesarean deliveries on severe maternal and adverse perinatal outcomes at a university hospital in Tanzania.
abstract: OBJECTIVE
  To investigate if multiparous individuals who had undergone a previous cesarean delivery experienced an increased risk of severe maternal outcomes or adverse perinatal outcomes compared with multiparous individuals who had undergone previous vaginal deliveries.
  
  
  METHODS
  An analytical cross-sectional study at a university hospital in Dar es Salaam, Tanzania, enrolled multiparous participants of at least 28weeks of pregnancy between February 1 and June 30, 2012 . Data were collected from patients' medical records and the hospital's obstetric database. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to compare outcomes among patients who had or had not undergone previous cesarean deliveries.
  
  
  RESULTS
  A total of 2478 patients were enrolled. A previous cesarean delivery resulted in no increase in the risk of severe maternal outcomes (OR 0.86, 95% CI 0.58-1.26; P=0.46), and decreased risk of stillbirth (OR 0.42, 95% CI 0.29-0.62, P<0.001), and intrapartum stillbirth and neonatal distress (OR 0.58, 95% CI 0.38-0.87, P=0.007).
  
  
  CONCLUSIONS
  Previous cesarean delivery was not a risk factor for severe maternal outcomes or adverse perinatal outcomes. The present study was conducted at a referral institution, where individuals with previous cesarean deliveries may constitute a healthy group. Additionally, there could be differences between the study groups in terms of healthcare-seeking behavior, referral mechanisms, intrapartum monitoring, and clinical decision making.
authors: International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. Electronic address: helena.litorp@kbh.uu.se.
authors: Helena
authors: H
authors: Litorp
authors: International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors: Mattias
authors: M
authors: Rööst
authors: International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania.
authors: Hussein L
authors: HL
authors: Kidanto
authors: Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
authors: Lennarth
authors: L
authors: Nyström
authors: International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors: Birgitta
authors: B
authors: Essén
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix; D000066491:Clinical Decision-Making; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010298:Parity; D011183:Postoperative Complications / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012044:Regression Analysis; D050497:Stillbirth / Q000453:epidemiology*; D013636:Tanzania; D055815:Young Adult
keywords: Cesarean section; Low-income countries; Maternal near-miss; Previous scar; Tanzania