Indications and rate of primary cesarean sections in a tertiary maternity hospital in southwestern Tanzania: A cross-sectional study

Primary cesarean section (PCS) rates are increasing globally, including in low-resource settings. Understanding the indications and determinants of PCS in referral hospitals is key to improving intrapartum decisions and maternal outcomes. To determine the proportion of PCS, identify common indications, and describe associated maternal and fetal factors. A retrospective hospital-based cross-sectional study was conducted using delivery records from November 2023 to January 2024. Data on maternal characteristics, fetal status, and neonatal outcomes were extracted from the hospital records. The determinants of PCS were identified using multivariable logistic regression analysis. Statistical significance was set at p ≤ 0.05. Among 1,558 deliveries, 35.2% were vaginal, 38.7% were repeat cesarean sections (CS), and 26.1% were PCS, yielding an overall CS rate of 64.8%, which was 29.6% higher than vaginal birth. PCS occurred most frequently among women aged 20–24 (26.6%), 25–29 (27.2%), and 30–34 (22.3%) years, with 12.3% aged ≤ 19. The leading indications for PCS were non-reassuring fetal status (46.2%) and cephalopelvic disproportion (28.2%). At the time of decision, 91.4% of the women were normotensive, 83.1% had hemoglobin levels ≥ 11 g/dL, and 88% had no preexisting conditions. Hypertension reduced the odds of PCS (OR 0.146 [95% CI: 0.041–0.529], p = 0.003). Bradycardia increased the odds (OR 2.299, [95% CI: 1.041–5.075], p = 0.039), whereas tachycardia decreased the odds (OR 0.026, [95% CI: 0.003–0.199], p < 0.001). The rate of cesarean deliveries was higher than that of vaginal births. The primary indications for PCS were non-reassuring fetal status (NRFS) and cephalopelvic disproportion (CPD). Strengthening intrapartum fetal monitoring and ensuring adherence to guideline-based criteria may reduce unwarranted variations in PCS decision-making.