A cross sectional study of rate, indications and complications of primary caesarean section

Abstract

Background:The indications for cesarean sections have been undergoing a gradual change over the last few decades. Besides the obstetric causes, several other medical, social, ethical, economic and medico legal factors play a role in this rising trend of cesarean section. Initially it was performed mainly for maternal interest but recently the health of the fetus has played a significant role in making the decision for a cesarean birth. This study was conducted to determine the rate, indications and complications of primary cesarean section in primi and multiparae. Methods: This was a cross sectional study carried out on primary cesarean section in the Department of Obstetrics and Gynecology, P.D.U. Medical College and Hospital, Rajkot during one year period from April 1, 2014 to March 31, 2015. During this study, patients (booked or unbooked) attending the labour room, undergoing primary cesarean section in the department will be selected according to the inclusion criteria. Their intraoperative and postoperative complications would be noted and also maternal and fetal morbidities and complications if any. The study does not include women who had Gestational age of less than 28 weeks, who underwent cesarean section in previous pregnancy, previous uterine surgery or hysterotomy and who had multiple gestations. Results: Out of 7295 deliveries performed during one year period, overall 1349 CS were performed with an incidence of 18.5%. The frequency of primary cesarean section was higher in primipara (72.4%) than multipara (27.6%) women. Emergency cesarean section (79.3%) was performed more than elective cesarean section (20.7%) in both the study group and most of them, did not taken ANC. 28.5% of the patients were unbooked and 46.6% of the patients were referred. Illiteracy was present in 31.7% cases and 62.6% cases belonged to rural areas. Anemia, malpresentations, oligohydramnios, eclampsia and preeclampsia were more common antenatal complications in primipara patients than multipara patients, while APH was more common complication in multiparity. In unbooked patients, anemia was found more commonly. Malpresentation (34.3%) was the commonest indication for cesarean sections in both the study groups. Intraoperative complications like extension of uterine incision, placenta praevia, PPH were found more in caesarean section done in emergency than electively and more in multipara patients. Maternal morbidity was seen in 18.5% of cases and more in multipara (25.4%) than primipara (15.9%). Abdominal distension, wound gap and fever were the common morbidities while no maternal mortality in the present study. 330 out of 685 babies were admitted in NICU and majority of them were for jaundice, preterm care and birth asphyxia. Perinatal mortality in the study was 6.6% and among them antepartum hemorrhage has the highest perinatal mortality rate. Prematurity was the most common cause of neonatal deaths. Conclusions: From this tudy, we concluded that overall CS rate is 18.5% and rate of vaginal delivery is 82.1% of t...

Analysis of caesarean rate, indications and complications: review from medical college Ambala, Haryana, India

“…15 Mean age of our study participants was 12.16 years with maximum (36.5%) patient between 26-30 year age group, which was comparable with other studies, in our study 183 (39%) patients were nulliparous, primary cesarean rate was quite high (88.8%) in our study then earlier studies. 2,13 Fetal distress was the commonest indication (25.1%) of LSCS in our study, followed by previous cesarean section (22.2%). Among preexisting obstetric indications hypertensive disorders of pregnancy contributed to LSCS in 87 (18.3%) patients, 39 (8.2%) had ante partum eclampsia.…”

“…Our results are similar to earlier reports from other medical colleges of India on the contrary Daniel S et al reported higher incidence (total 28.7%) elective 46.06% and 53.9%) although the observed incidence in our study is far lower than reported from sub-Saharan countries. 2,11,13,14 In Asia survey the overall cesarean rate was 27.3%. China had the highest overall cesarean rates (46.2%) followed by Vietnam, Thailand and Sri Lanka; Cambodia had the lower (14.7%).…”

“…12 In agreement with earlier studies atonic post-partum hemorrhage was most commonly met complication in our study contributing in 41 (8.6%) patients irrespective of Perinatal mortality rate of 4.6% was found in the study which was lower than earlier studies, the profile of neonatal complications observed in present study were in harmony with previous reports, neonatal jaundice being the commonest (215 babies) complication followed by sepsis then birth asphyxia. 2 Limitation of the study was that, the institute is a tertiary care centre situated in rural area; hence we are getting high risk referral cases which may be the cause of greater number of emergency LSCS. This study does not include cases operated in private sector.…”

“…Initially it was performed mainly for maternal interest but recently the health of the fetus has played a significant role in making the decision for a caesarean birth. 2 CS may be associated with short term and long term risks. Short-term maternal risks associated with CS include bleeding, injury of urogenital or gastrointestinal organs, postoperative infection and an increased risk for deep venous thrombosis.…”

Indications and foeto-maternal outcome of emergency cesarean sections in rural Mewar region

“…Initially it was preferred for maternal interest but nowadays foetal health has also played a significant role. 6 CS may be associated with short term and long term risks. Short term maternal risks associated with a CS includes bleeding, injury to the urogenital or gastrointestinal organs, post-operative infection and risks for deep vein thrombosis.…”