Rising Cesarean Section Rates: A Tertiary Hospital Perspective

Abstract

Aim: To understand the reasons for rising cesarean section rates in tertiary hospitals. Materials and methods: Analysis of emergency obstetric referrals was done during the period January 1, 2015 to December 31, 2017. Data only from those emergency duties done by the corresponding author were included to avoid subjective variation. A total of 86 emergency duties, which included duties on working days, weekends, and public holidays, were done. A total of 309 deliveries were conducted during emergency duty hours, and a total of 107 emergency referrals were received from other hospitals/practitioners. Results: It is very difficult to substantiate the reasons for referral for many reasons; many cases are referred without a proper referral letter or they are referred over phone. The severity of the condition for which the patient is referred is usually much more than what is mentioned by the referral doctor and by what is determined on initial assessment at the tertiary center. This could be due to time lost and worsening of the situation, during transit. Conclusion: While managing an emergency obstetric referral, an obstetrician in a tertiary center must evaluate the case with a certain degree of suspicion and should have a lower threshold for operative intervention. This is mainly because there might be incomplete information and worsening of the condition due to delays, which is usually underestimated. Blood products are a precious commodity and are in limited stock, and the investigations take some time to become available to the obstetrician. Clinical significance: Obstetricians in tertiary institutions are privileged because they get an opportunity to manage less common complications, and hone their skills. However, their responsibility should extend beyond patient care and they must communicate to the referring doctor about lapses and convince them to refer much earlier with detailed notes.