Are we operating unnecessarily?: caesarean audit in a single unit of a private tertiary care hospital in North India
Keywords:Caesarean section, Caesarean audit, Robson’s classification, Tertiary hospital
Background: Caesarean section emerged as a lifesaving surgery in situations where vaginal delivery could put the mother and fetus at risk. Over the years global rise in caesarean delivery rate has been alarming and may be attributed to changes in medical practice and societal expectations, especially in urban areas and developing countries. Rising caesarean rate is worrisome as it increases maternal morbidity, exposes the mother to future obstetric risks, besides increasing financial burden on the health care system. Caesarean audits could be an effective tool to analyse, understand and propose solutions to reduce caesarean rates. Hence, this retrospective study was conducted to audit caesarean sections done over a period of 5 years (2011 to 2015) in a single unit of a tertiary care private hospital in North India.
Methods: The case records of all caesarean deliveries from January 2011 to December 2015 were analysed retrospectively for demographic profile, clinical parameters and recorded indication of caesarean section on the basis of Robson’s classification.
Results: The caesarean section rate in the study was 61.8%. According to Robson’s 10 system classification, Group 2, 5 and 10 were the largest contributors. The commonest indication was previous LSCS (18.7%) followed closely by fetal distress (15.4%) and prolonged labor/failed induction (13.3%). Maternal request contributed 10.6% of the Caesarean deliveries.
Conclusions: The caesarean section rate in our study is way higher than the national average. We need to re-duce caesareans in primigravidae and consider VBAC where appropriate. Use of Electronic fetal monitoring during labor needs to be optimized. Appropriate use of oxytocics, proper monitoring and using robust criterion to infer non progress of labor are important. Appropriate counselling and assured pain management during labor may help reduce caesareans on maternal request.
World Health Organisation. Appropriate technology for birth. Lancet. 1985;326(8452):436-37.
Kambo I, Bedi N, Dillon BS, Saxena NC. A critical appraisal of caesarean section rates at teaching hospitals in India. Inter J Obstet Gynaecol. 2002;79:151-8.
Ghosh S. Increasing trends in caesarean section delivery in India, Role of medicalization of maternal. In Working Papers. The institute of Social and Economic Change, Bangalore; 2010.
McCourt C, wearer J, Statham H, Beake S, Gamble J, Creedy DK. Elective caesarean section and decision making: a critical review of literature. Birth. 2007;34;65-79.
Mackenzie IZ, Cooke I, Annan B. Indications for caesarean section in a consultant unit over the decade. J Obstet Gynecol. 2003;23:233-8.
Bharadwaj M, Modi J. four year audit of deliveries by caesarean section at a medical college hospital in Central India. Int J Reprod Contracept Obstet Gyenecol. 2015;4:1775-82.
Sreevidya S, Sathiyasekaran BW. High caesarean rates in Madras (India): a population based cross sectional study. Br J Obstet Gynecol. 2003;110:106-11.
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.
Sajjad R, Ali CA, Iqbal A, Sajjad N, Haq MZ. An audit of caesarean sections in Military Hospital Rawalpindi. Anaesth Pain Intens Care. 2014;18(2):172-5.
Staton CK, Holtz Sa. Levels and trends in caesarean births in the developing world. Stud Fam Plan. 2006;37(1):41-8.
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. Pediatr Perina Epidemiol. 2007;21:98-113.
Naidoo N, Moodley J. Rising rates of caesarean sections in specialist private practice. SA Fam Pract. 2009;51(3):254-8.
Barber EL, Lundsberg LS, Belanger K, Penker CM, Funai EF, Illuzzi JL. Indications contributing to the increasing caesarean delivery rate. Obstet Gynecol. 2011;118 29-30.
Qazi M, Saqib N. Rising trend of caesarean section in a tertiary care hospital over half a decade: a retrospective study. Int J Reprod Contracept Obstet Gynecol. 2018;7:4097-102.