Vaginal birth after cesarean section (VBAC) versus emergency repeat cesarean section at teaching hospitals in India: an ICMR task force study

Background: There is a global concern for rising rates of deliveries by Caesarean Section over the past few decades. Caesarean deliveries are not only associated with a higher morbidity and mortality but also a longer duration of hospital stay and greater financial burden. Hence they are justified only where better perinatal outcome is expected. An audit of indications of caesarean sections may help identify the areas of intervention for reducing the caesarean delivery rates. Methods: The delivery records were analyzed retrospectively from January 2008 to December 2011. The rates and indications for deliveries by caesarean section were analyzed. Results: The total number of deliveries in the three year period was 4084. Of these, 1965 deliveries were caesarean deliveries (48.1%). Year wise, a rising trend in caesarean section rate was noted: 40.8% in 2008; 46% in 2009; 48.7% in 2010 and 56.5% in 2011. The leading indication for caesarean section was fetal distress (35%). The others major indications were previous caesarean delivery (26%), Cephalo Pelvic Disproportion (10.4%), Malposition/malpresentation (8.2%), prolonged labour (7.8%), Hypertensive disorders of Pregnancy (2.2), Antepartum haemorrhage (2%) and Obstructed labour (1.7%). The proportion of CS done for previous caesarean section steadily increased over the four years and a falling trend was noticed for CS done for prolonged labour. Conclusions: The rate of caesarean section needs to be closely monitored and audited so as to take measures for reducing the caesarean rates. An in depth analysis of caesareans section done for fetal distress and previous CS is recommended so that areas of intervention can be identified. The decision for primary CS should be done after a comprehensive assessment and with due justification.

Section: Resultsmentioning

confidence: 98%

Section: (62)mentioning

confidence: 99%

A four year audit of deliveries by caeserean section at a medical college hospital in Central India

Bharadwaj¹,

Modi²

2015

“…The task force of the Indian Council of Medical Research (ICMR) recognizes that there is a delicate balance of benefits and harms as far as a planned vaginal delivery is concerned in women with previous CS. 14 The task force in its multicentric audit at 30 medical colleges in India concluded that the choice of repeat CS or planned VD in a mother with a scarred uterus is one of the most significant and challenging issues in obstetric practice. 14 This is because of the risk of uterine rupture that comes inherently associated with a trial of labour after caesarean (TOLAC) which is an obstetrician's nightmare.…”

Section: Discussionmentioning

confidence: 99%

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

Yerra¹,

Khan²

2020

Background: Caesarean section (CS) is a potentially life-saving surgery when performed for indicated reasons. The rates of CS deliveries have sky rocketed in the last few years. A CS does not come without complications and risk and therefore its trends in all institutes should be audited for ensuring optimization of obstetric care standards. Methods: The study was conducted as a retrospective analysis of all the CS deliveries for 12 months and their categorization using the WHO recommended Robson ten group classification system; with an aim to evaluate and understand the indication for each CS performed in the institute. The Robson was further subclassified to closely understand the circumstances in which the CS was performed in each group. Results: In this study evaluated a total of 2831 deliveries out of which 1557 (55%) were CS births. Out of these CS births, 48.5% were indicated for emergency indications. Class 5, 1 and 10 were the main contributors to the CS rate with 50.6%, 19.3% and 10% contributions respectively. From a total of 799 patients with previous CS, only 12.1% could have a successful trial of scar. The most common indications documented for Group 1 was foetal distress, cephalo pelvic disproportion and prolonged labour, in decreasing order. Among the singleton pre-terms who had a CS, a majority (92.3%) were operated before the onset of labour. Conclusions: The audit helped to understand the trends of CS in the institute and helped in the realizing that all the CS in the institute has questionable indications. This led to implementation of clinical and administrative reforms to ensure a reduction in unnecessary CS being performed.

“…2 And also, according to National Family Health Survey-4 (NFHS-4) the average rate of CS from 2.9% in 1992, has been increased to 17.2% in 2015 ranging from 5.8% in Nagaland to 58% in Telangana. 11 In the present study, the prevalence of CS rate was found to be 35.9% which is almost identical to ICMR task force study.…”

Section: Discussionmentioning

confidence: 99%

Audit of caesarean deliveries in a tertiary care hospital of northern Andhra Pradesh using modified Robson criteria

Prabhavathi¹,

Krishnamma²,

Prasad³

et al. 2018

INTRODUCTIONToday there is an increased trend in the incidence of caesarean section (CS) rate worldwide particularly in middle-and high income countries, even with the lack of evidence supporting considerable maternal and perinatal benefits with CS rates higher than a certain threshold.The ideal CS rate should be between 10-15% as WHO recommended and was an accepted norm until 2014. 1Although CS is a life saving procedure for both mother and baby, the incidence of neonatal mortality and morbidity did not decrease with the increase in CS rates.The following reasons have been designated for the rise of CS rates include fear of medico-legal issues, increasing maternal request, increasing malpractice pressure, convenience of scheduled deliveries as well as economic, cultural and organizational factors.However, ICMR task force study stated after considering data from 30 teaching institutions that the most frequent ABSTRACT Background: Today, there is an increased trend in the incidence of caesarean section (CS) rate worldwide particularly in India, even with the lack of evidence supporting considerable maternal and perinatal benefits with higher CS rates. The main objective of our study was to find the incidence of CS rate, auditing the data on the basis of modified Robson criteria, factors responsible for the most common group, to know the changing trends of CS and finally put forth the strategies to reduce CS rate. Methods: This is a retrospective study of 472 CS cases carried out in a tertiary care hospital during the year 2016. All the cases were grouped according to the modified Robson criteria and the data was analyzed. The data were grouped into 3 different slots of 4 months each (FF = first four months; MF = middle four months and LF = last four months of the year 2016). Results: A significant increasing trend was observed in the groups of 2B and 5C where as a significant decreasing trend was noticed in 6C and 7C. The most common indications for caesarean delivery were cephalo-pelvic disproportion (CPD) (28%) and fetal distress (22%) in group 1 whereas in group 2A CPD, fetal distress and failed induction were found to be 12%, 24% and 30% respectively. Conclusions: The change in trend has been noticed in the last few months particularly in 2B and 5C groups suggesting that there is a change in the attitude of obstetricians in conducting caesarean deliveries before the onset of labour rather than performing CS after the onset of labour. Targeting 2B along with 5C would help our efforts in reducing the CS rate.