A four year audit of deliveries by caeserean section at a medical college hospital in Central India
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20150927Keywords:
Caesarean delivery, Caeserian section rate, IndicationsAbstract
Background: There is a global concern for rising rates of deliveries by Caesarean Section over the past few decades. Caesarean deliveries are not only associated with a higher morbidity and mortality but also a longer duration of hospital stay and greater financial burden. Hence they are justified only where better perinatal outcome is expected. An audit of indications of caesarean sections may help identify the areas of intervention for reducing the caesarean delivery rates.
Methods: The delivery records were analyzed retrospectively from January 2008 to December 2011. The rates and indications for deliveries by caesarean section were analyzed.
Results: The total number of deliveries in the three year period was 4084. Of these, 1965 deliveries were caesarean deliveries (48.1%). Year wise, a rising trend in caesarean section rate was noted: 40.8% in 2008; 46% in 2009; 48.7% in 2010 and 56.5% in 2011. The leading indication for caesarean section was fetal distress (35%). The others major indications were previous caesarean delivery (26%), Cephalo Pelvic Disproportion (10.4%), Malposition/malpresentation (8.2%), prolonged labour (7.8%), Hypertensive disorders of Pregnancy (2.2), Antepartum haemorrhage (2%) and Obstructed labour (1.7%). The proportion of CS done for previous caesarean section steadily increased over the four years and a falling trend was noticed for CS done for prolonged labour.
Conclusions: The rate of caesarean section needs to be closely monitored and audited so as to take measures for reducing the caesarean rates. An in depth analysis of caesareans section done for fetal distress and previous CS is recommended so that areas of intervention can be identified. The decision for primary CS should be done after a comprehensive assessment and with due justification.
References
Betran AP, Merialdi M, Lauer JA, Bing-shun W, Thomas J, van Look P, et al. Rates of caesarean section: Analysis of global, regional and national estimates. Pediatric and Perinatal Epidemiology. 2007;21:98-113.
Roy Choudhary C. Caesarean births: the Indian scenario. Abstract. Presented at the Population Association of America 2008 Annual meeting. 17-19 April 2008. New Orleans, USA.
Stanton CK, Holtz SA. Levels and trends in caesarean births in the developing world. Studies in Family planning. 2006;37(1):41-8.
Ado D, Geidam BM, Audu BM, Kawuwa J, Obed Y. Rising trends and indications of caesarean section at the university of Maiduguri teaching hospital Nigeria. Annals of African Medicine. 2009;8(2):127-32.
Unnikrishnan B, Rakshith P, Aishwarya A, Nithin K, Rekha T, Prasanna P, et al. Trends and Indications for Caesarean Section in a tertiary care Obstetric Hospital in Coastal South India. Australasian Medical Journal. 2010;3:821-5.
WHO Joint interregional conference on appropriate technology for birth. Fortaleza, Brazil, 22-26 April, 1985.
World Health Organization. Appropriate technology for birth revisited. Br J Obstet Gynaecol. 1992;99:709-10.
Department of Reproductive Health and Research. WHO statement on Caesarean Section rates, 2015. World Health Organization, Geneva.
Mukherjee SN. Rising caesarean section rate. J Obstet Gynecol India. 2006;56(4):298-300.
Naidoo N, Moodley J. Rising rates of caesarean sections in specialist private practice. SA Fam Pract. 2009;51(3):254-8.
Sajjad R, Ali CA, Iqbal A, Sajjad N, Haq MZ. An audit of cesarean sections in Military Hospital Rawalpindi. Anaesth Pain & Intensive Care 2014;18(2):172-5
Goonewardene M, Kumara DMA, Arachchi DRJ, Vithanage R, Wijeweera R. The rising trend of caesarean section rates: should we and can we reduce it? Sri Lanka Journal of Obstetrics and Gynaecology. 2012;34:11-8.
Kambo I, Bedi N, Dillon BS, Saxena NC. A critical appraisal of caesarean sectionrates at teaching hospital in India. International J Obstet Gynaecol. 2002;79:151-8.
Ghosh S. Increasing trends in caesarean section delivery in India, Role of medicalization of maternal health. In Working Papers. The Institute of Social and Economic Change, Banglore, 2010.
Gibbons L, Belizan JM, Lauer JA, Betran AP, Merialdi M, Althabe F. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: Overuse as a barrier to universal coverage. World Health Report, 2010.
Goonewardene M, Manawadu MH, Priyaranjana DV. Audit: The strategy to reduce the rising caesarean section rates. J South Asain Feder Obstet Gynae. 2012;4(1):5-9.
Pahari K, Ghosh A. Study of pregnancy outcome over a period of five years in a postgraduate Institute of West Bengal. J Ind Med Assoc. 1997;95(6):172-4.
Sreevidya S, Sathiyasekaran BW. High caesarean rates in Madras (India): a population-based cross sectional study. Br J Obstet Gynaecol. 2003;110(2):106-11.
Dhillon BS, Chandhiok N, Bhatia BS, Coyaji KJ, Das MC, Das V, et al. Vaginal birth after caesarean section (VBAC) versus emergency caesarean section at teaching hospitals in India: an ICMR task force study. Int J Reprod Contracept Obstet Gynecol. 2014;3(3):592-7.
Dhodapkar SB, Bharavi S, Daniel M, Chauhan NS, Chauhan RC. Analysis of caesarean sections according to Robson’s ten group classification system at a tertiary care teaching hospital in South India. Int J Reprod Contracept Obstet Gynecol. 2015;4(3):745-9.
Balakrishnan D, Nair VR. Our exploding cesarean rates: A system for auditing. Journal of Evolution of Medical and Dental Sciences. 2014;3(14):3563-7.
Thomas J, Paranjothy S. Royal College of Obstetricians and Gynaecologists, Clinical Effectiveness Support Unit. The National Sentinel Caesarean Section Audit Report. London: RCOG Press, 2001.