Classifying caesarean section rate using the Ten group classification system

Abstract

Abstract Classifying caesarean section rate using the Ten group classification system – a descriptive study at Kilimanjaro Christian Medical Centre, Moshi, Tanzania. Degree Project, Programme in Medicine, Annika Malmborg, 2016, Dept of Obstetrics and Gynaecology, Gothenburg University, Sweden and Dept. Of Obstetrics at KCMC, Moshi, Tanzania Background: Caesarean section (CS) can be life-saving for mother and child but the operation can be followed by instant or longterm complications for both. CS rates are increasing in both high income and low income countries. The WHO recommend no higher CS rate than 15 % but at KCMC the rate exceeds 40 %. To keep the CS rate on an adequate level, the Ten group classification system (TGCS), has been increasingly used to classify women before delivery in ten groups and calculate the CS rate in each group in order to at long sight improve the CS rate by adequate measures. The indications for CS differs a lot in various settings, especially the percentage of maternal request for CS. Aims: To classify the women giving birth at KCMC into the ten groups, to analyse the CS rate in each group and also to describe the main indications for CS. Methods: Retrieve information needed for classification from the delivery book and case files for women giving birth at KCMC during the data collection period. Results: The CS rate was 40.8%. The nulliparous women, and the women who have had a previous CS contribute most to the overall CS rate. Nulliparous women had a higher risk of CS than the multiparous, especially when labour was induced. The main indications for CS were disproportion, poor progress of labour and non-reassuring fetal status (NRFS). For women with one previous CS, with a CS rate of 80%, the leading cause for CS was maternal request. Conclusion: High CS rates among nulliparous is leading to an increase of women with a previous scar, in which group the risk of another CS is substantial - a domino-effect. When trying to lower CS rates, focus should be aimed at improving management of the nulliparous women to avoid the first CS. Key words: Caesarean section rate, Ten group classification system, main indication, KCMC, Tanzania