Retrospective analysis of indications of primary caesarean sections done at a tertiary care hospital

Abstract

Background: Caesarean section rates have globally risen above the levels that can be considered medically necessary. The aim of the study is to analyze the rate and indications of caesarean sections for primigravidae in the period 2016 to 2018 at a tertiary care hospital in Delhi.Methods: It is a retrospective observational study conducted in the Department of Obstetrics and Gynaecology at PGIMER and Dr RML Hospital, New Delhi. A total of 552 caesarean deliveries in primigravidae were studied.Results: The total deliveries during the study period were 3346 and the total caesarean section rate observed was 30.66%. The caesarean section rate among primigravidae was 29.1%. The rate of caesarean section in primigravidae rose from 22.7% in 2016 to 39.3% in 2018 with 17% increase. Majority of them belonged to the age group 20-30 years (79.34%) and 2.53% were elderly primigravidae. Out of the total number of primigravidae caesarean deliveries, 67.2% were performed in emergency and 32.7% were performed electively. Among the emergency caesarean sections performed, 64% of patients had induced labor and 22% had spontaneous labor. The most common indication of caesarean section was fetal distress (19.77%) followed by arrest of labor (17.87%) and malpresentations (8.9%). The short-term caesarean morbidity rate was 25.4% including one mortality. Wound infection was the most common complication.Conclusions: Various reasons like changing maternal risk profile increased IVF pregnancies, scientific advances, personal choice and medico legal considerations have been cited for increased caesarean rate. Following evidence-based labor protocols, judicious use of cardiotocography, proper patient selection for labor induction and patient education will contribute in reduction of caesarean sections and related complications.

A clinical study of primary caesarean section at a tertiary care hospital in coastal city: an observational study

“…This result correlates with the study done by Datta et al where the maximum primary caesarean were performed at 37-40 weeks of gestational age (74.14%). 5 In our study the number of emergency primary caesarean was 79.2% compared to 20.8% which was done as elective cases. This result correlates with the study done by Datta et al, Jain et al and Moni et al and other studies where the emergency caesarean sections were higher than elective caesarean.…”

“…In a study done by Datta et al, it showed that the maximum number of cases (79.34%) had an age between 20-30 years which is very similar to the study done by Jain et al, Mande et al, by Rajbhandary et al, by Rao et al, Boyle et al as well as our study where the maximum age distribution was seen among 18-27 years of age (62.3%). 5,8,9,[11][12][13] This shows that most of the primigravida who underwent caesarean section were in the age group of 20-30 years in most studies. Our study had 16 elderly primigravida accounting to 4.2% of the study population.…”

“…The study done by Datta et al also shows a highest indication rate for fetal distress (19.77%) followed by non-progression of labour (17.87%) followed by altered Doppler values with severe FGR (10.26%). 5 The study done by Jain et al and Rao et al, however, shows that maximum caesarean sections were done for malpresentation (34-40%). 11,12 All the other studies correlated with our study which showed fetal distress to be the most common indication for primary caesarean.…”

“…It has been observed that caesarean deliveries are associated with increased risk of maternal and perinatal morbidity and postoperative complications as compared to vaginal deliveries. 5 In the past 10 years, the rate of caesarean deliveries is increasing among the twin gestations. Perinatal outcomes for twin gestations in which the first twin is cephalic are not improved by caesarean delivery.…”

“…6 A phenomenal rise in the Assisted Reproductive Techniques (ART) due to rising rate of infertility and advanced maternal age has also led to increase in caesarean sections. 5 According to a study by Indian council of medical research (ICMR), the incidence of caesarean sections is 25.4% for the years 1998-1999. Evidence from research studies shows there is a growing tendency for caesarean deliveries especially during complications confronted at the time of pregnancy and delivery.…”