Analysis of indications of caesarean section: A retrospective study in a tertiary care hospital, to curb the rising caesarean section rate

Abstract

OBJECTIVE: To examine the indications leading to the overall escalation of  Caesarean Section(CS) rate in our population   and to put forward strategies/interventions where possible practically to curb the escalating rates of CS in a tertiary care hospital.

MATERIAL AND METHODS:

This Retrospective Cross-sectional study was conducted in obstetrics department of Lady Reading Hospital Peshawar, for a period of 1 year from January 2021 till December 2021. The data was collected from hospital’s clinical records of the women who had CS delivery during the study period. Required information was entered into a structured Proforma. Data was analyzed on SPSS version 21.

RESULTS:

During the study period n=7376 women delivered in the obstetrics unit A, of Lady Reading Hospital. Out of these n=1679(22.76%) were Caesarean Sections. The number of Primary CS were n=1021(60.81%) while n=658(39.18%) were repeat CS.  It was found that most of the CS n=1066(63.49%) were Emergency CS while n=613(36.51%) were Elective CS.

The most common indication for CS was Repeat CS in women with history of previous CS deliveries n=658 (39.19%).The 2^nd most common indication was fetal distress n=302(18.04%) followed by Labour progress disorders n=235(13.99%).

CONCLUSION:

Majority of the women who underwent CS had the history of previous CS deliveries. It is the need of the day to educate the obstetricians and counsel/encourage women in antenatal period regarding the safety of procedures like externat cephalic version (ECV), trial of labour after caesarean section (TOLAC)and vaginal birth after caesarean section (VBAC), to reduce repeat CS in our setup.procedures like External Cephalic Version (ECV), Trail of Labour after previous Caesarean-Section (TOLAC) and Vaginal Birth after previous Caesarean Section (VBAC), if we want to reduce repeat CS in our setup. Moreover, CTG should be used only in high risk pregnancies/labours. Furthermore, adherence to WHO Labour Care Guide and skills and drills for reviving instrumental delivery in carefully selected cases may curb the escalating rate of CS.