Association between first birth cesarean delivery and adverse maternal-fetal outcomes in the second pregnancy: a registry-based study in Northern Tanzania

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Abstract Background: Cesarean delivery is the commonest obstetric surgery and surgical intervention to save lives of the mother and/or the new-borns. It has been accepted as safe procedure, yet it has increased risk of adverse maternal and fetal outcomes. The rise in rate of cesarean delivery has been a major public health concern worldwide. Previous caesarean section has been associated with repeated cesarean delivery, causing potential adverse maternal-fetal outcomes in the subsequent pregnancy. We aimed to examine the relationship between first birth cesarean delivery and adverse maternal-fetal outcomes in the subsequent pregnancy among women who delivered at Kilimanjaro Christian Medical Centre in Northern Tanzania. Methods: A retrospective cohort study was conducted using maternally-linked data from Kilimanjaro Christian Medical Centre. All women who had singleton second delivery between the years 2011 to 2015 were studied. A total of 5,984 women with singleton second delivery were analysed. Multivariable log-binomial regression was used to determine the association between first cesarean delivery and maternal-fetal outcome in subsequent pregnancy. Results: Cesarean delivery in the first birth was associated with an increased risk of adverse maternal and fetal outcomes in the subsequent pregnancy. These included repeated cesarean delivery (ARR 1.19; 95% CI: 1.05-1.34), pre/eclampsia (ARR 1.38; 95% CI: 1.06-1.78), gestational diabetes Mellitus (ARR 2.80; 95% CI: 1.07-7.36), uterine rupture (ARR 1.56; CI: 1.05-2.32), peri-partum hysterectomy (ARR 2.28; CI: 1.04-5.02) and preterm birth (ARR 1.21; CI: 1.05-1.38). Conclusion: Women with CD in their first pregnancy had an increased risk of repeated CD and other adverse maternal-fetal outcomes. Findings from a present study highlight the importance of devising regional specific measures to mitigate unnecessary primary caesarean delivery. Additionally, this information may serve as a basis to guide mode of delivery counselling prior to Trial of labour after caesarean delivery.

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