A clinical audit and confidential enquiry of caesarean section indications at rural tertiary health care centre

Abstract

Background: Worldwide CSR has been steadily increasing beyond recommended level of 15 %by WHO. High CSR have been reported in developed and developing countries. Reasons for increase in CSR are not obvious and somewhat complex. Thus, present study was undertaken to analyze various indications for CS performed at rural tertiary health care centre Sewagram, M.S.Methods: This was prospective study included all women who underwent CS from 1st January 2015 till 30th June 2016. Data was entered in MS excel sheet analyzed with percentage and chi square test using SPSS ver.17.Results: CSR was 36 .88% in present study. As per NICE guidelines CS were classified in four categories based on urgency, women were distributed in each category. Category I had 22.62%, category II -38.61%, category III - 28.37% and Category IV - 10.40% women. In CAT I common indication was foetal bradycardia (71.53%). In CAT II CS, common indication was non reassuring foetal status (38.82%). Breech presentation (14.74%) and previous scar with doubtfull scar integrity (14.33) were next common indications. In CAT III (43.43%), IV (41.13%) previous LSCS with inadequate pelvis was the common indication. Confidential enquiry revealed that 26.17% (28/107), 20.3% (40/197), 23.17%, (35/151) and 8.3 % (5/60) of CAT I, II, III and IV CS had questionable indications.Conclusions: In this study, CSR was higher than WHO standard. Common indications in primipara was foetal distress while in multiparas primary indication previous LSCS

An audit of the decision to delivery interval in emergency caesarean section and its effect on neonatal outcome

“…The percentage of cases in category 1 and 2 and the commonest indication for emergency CS in these categories was comparable to the study done by Thool et al 11 We could deliver 19.5% of category 1 within 30 minutes which was comparable to that of a study done in a tertiary care hospital in Thailand. 12 We realised that we need to improve the efficiency of our team in category 1 CS.…”

Analysing trends in caesarean sections at a tertiary care teaching hospital in South India: findings from a clinical audit using Robson criteria

“…10 Similarly an audit at a tertiary care teaching hospital in 2017 revealed a CS occurrence of 36.88%. 2 Another medical college hospital in central India audited the CS for 4 year and found a 48.1% prevalence of abdominal deliveries. 3 These wide variations could be attributed to the varied population samples that present to these centres for their delivery.…”

“…Similarly, an audit performed by Thool et al in India revealed that previous CS was the largest contributor of Category 3 CS, which includes women with no maternal or foetal compromise but requires an urgent delivery. 2 Another audit at a medical college in Bhopal found that the second most common indication document in operative notes was previous CS. 3 Keeping with such trends a Cochrane review in 2011 concluded that a second opinion should always be sought when planning the mode of delivery in those with previous CS apart from a pre CS consultation and a post CS surveillance.…”

“…When such a CS is performed the mother and the child are placed at an unreasonable risk of morbidity and mortality. 1,2 Moreover it also burdens the healthcare system by increasing expenditure of public resources and avoidable bed occupancy apart from deteriorating the quality of life of women in terms of post-operative morbidity and a reduction in their reproductive potential. 3,4 The department of reproductive health and research, World Health Organisation (WHO) established, by the way of systematic reviews, in 2014 that CS rates in population more than 10% up to 30% have no additional benefits in terms of maternal and neonatal survival.…”