Rising trend of caesarean section in a tertiary hospital over half decade: a retrospective study


  • Mahvish Qazi Department of Obstetrics and Gynecology, ASCOMS Jammu, Jammu and Kashmir, India
  • Najmus Saqib Department of Pediatrics, GMC Jammu, Jammu and Kashmir, India




Cesarean section, Elective, Emergency, Fetal distress


Background: Cesarean section (CS) rates are increasing worldwide; however, it can lead to significant increase in maternal and infant morbidity and mortality. This study aimed to determine the rates and trend of cesarean sections in Jammu (Jammu and Kashmir), India.

Methods: This was a retrospective hospital record-based study done in patients who were admitted in Government Medical College Jammu (Jammu and Kashmir) India in the Department of Obstetrics and Gynecology during the study period from Jan 2012 to Dec 2017 and data of CS was collected. The trends and indications for CS over the 5-year period were analyzed with SPSS 12.0 software.

Results: During the study period, annual number of deliveries in GMC Jammu increased from 14592 (2012) to 20417 (2017). CS rates increased from 4817 (33.01%) to 8378 (41.03%) with a hike of 8.02%. Commonest indication for CS was post CS pregnancies (25.43%-34.24%) followed by non-progress of labor (NPOL), fetal distress, breech presentation, antepartum hemorrhage, cephalo-pelvic disproportion (CPD) and severe pregnancy induced hypertension (PIH).

Conclusions: This study indicates that rapid socio-economic changes and the outlook towards medical intervention by the women, families and society are largely responsible for rising trend of CS. Other factors that have been reported for this are fear of pain; concerns about genital modifications after vaginal delivery; misconception that CS is safer for the baby; fear of medical litigation and lower tolerance to any complications or outcomes other than the perfect baby are responsible for the current high incidence of caesarean section in many states and urban centres with post cesarean pregnancy being the largest contributor. From doctors point of view, it is a defensive medicine to have better outcome.


Lumbiganon P, Laopaiboon M, Gülmezoglu AM, Souza JP, Taneepanichskul S, Ruyan P, et al. World Health Organization Global Survey on Maternal and Perinatal Health Research Group: Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-8. Lancet. 2010;375:490-8.

Villar J, Valladares E, Wojdyla D, Zavaleta N, Carroli G, Velazco A, et al. WHO 2005 Global Survey on Maternal and Perinatal Health Research Group: Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet. 2006;367:1819-29.

Laws PJ, Sullivan EA. Australia’s mothers and babies 2002. Perinatal Statistics Series No. 15. Sydney: National Perinatal Statistics Unit; 2004.

Tranquilli AL, Giannubilo SR. Cesarean delivery on maternal request in Italy. Int J Gynaecol Obstet. 2004;84:169-70.

Caesarean sections. Post note No.184. London: Parliamentary Office of Science and Technology; 2002.

Dobson R. Caesarean section rate in England and Wales hits 21%. BMJ. 2001;323:951.

Zahr CA, Wardlaw TM, Choi Y. Maternal mortality in 2000: estimates developed by WHO, UNICEF and UNFPA. World Health Organization; 2004.

Dosa L. Caesarean section delivery, and increasingly popular option. Bull World Health Organ. 2001;79:1173.

Board E. EBCOG position statement on caesarean section in Europe. European J Obstet Gynecol Reprod Biol. 2017;219:129.

Ghotbi F, Akbari Sene A, Azargashb E, Shiva F, Mohtadi M, Zadehmodares S, et al. Women's knowledge and attitude towards mode of delivery and frequency of cesarean section on mother's request in six public and private hospitals in Tehran, Iran, 2012. J Obstet Gynaecol Research. 2014;40(5):1257-66.

Mendoza-Sassi RA, Cesar JA, Silva PR, Denardin G, Rodrigues MM. Risk factors for cesarean section by category of health service. J Public Health. 2010;44(1):80-9.

Hopkins K, de Lima Amaral EF, Mourão AN. The impact of payment source and hospital type on rising cesarean section rates in Brazil, 1998 to 2008. Birth. 2014;41(2):169-77.

Indian Council of Medical Research (1990) Collaborative study on high risk pregnancies and maternal mortality (ICMR task force study). ICMR, New Delhi, India.

Kambo I, Bedi N, Dhillon BS, Saxena NC. A critical appraisal of cesarean section rates at teaching hospitals in India. Int J Gynecol Obstet. 2002;79(2):151-8.

Sreevidya S, Sathiyasekaran BW. High caesarean rates in Madras (India): a population‐based cross sectional study. BJOG: An Int J Obstet Gynaecol. 2003;110(2):106-11.

International Institute for Population Sciences, Mumbai National Family Health Survey (NFHS-1) 1992-93.

International Institute for Population Sciences, Mumbai National Family Health Survey (NFHS-2) 1998-99.

International Institute for Population Sciences, Mumbai National Family Health Survey (NFHS-3) 2005-06.

International Institute for Population Sciences, Mumbai (2017) National Family Health Survey (NFHS-4) 2015-16 India Fact sheet.

Stanton C, Ronsmans C. Recommendations for routine reporting on indications for caesarean delivery in developing countries. Birth. 2008;35:204-11.

Torloni MR, Betran AP, Souza JP, Widmer M, Allen T, Gulmezoglu M, et al. Classifications for caesarean section: a systematic review. PLoS One. 2011;6:e1456.

Singh G, Gupta ED. Rising incidence of caesarean section in rural area in Haryana, India: a retrospective analysis. Internet J Gynecol Obstetr. 2013;17(2):1-5.

Cuningham FG, Leveno KJ, Bloome SL, Hauth JC, Gilstrap LC, Wenstrom KD. Preterm birth. In: Rouse D, Spong C, Rainey B, Wendel GD, eds. Williams Obstetrics. 22nd ed. New York: McGraw-Hill; 2005: 865-866.

Lavender T, Hofmeyr GJ, Neilson JP, Kingdon C, Gyte GML. Caesarean section for non-medical reasons at term. Cochrane Database Syst Rev. 2006;3:CD004660.

McCourt C, Weaver J, Statham H, Beake S, Gamble J, Creedy DK. Elective cesarean section and decision making: a critical review of literature. Birth. 2007;34:65-79.

Zwecker P, Azoulay L, Abenhaim HA. Effect of fear of litigation on obstetric care: a nationwide analysis on obstetric practice. Am J Perinatol. 2011;28(04):277-84.

Hellerstein S, Feldman S, Duan T. China's 50% caesarean delivery rate: is it too high?. BJOG: An Int J Obstet Gynaecol. 2015;122(2):160-4.

Abdel‐Aleem H, Shaaban OM, Hassanin AI, Ibraheem AA. Analysis of cesarean delivery at Assiut University Hospital using the Ten Group Classification System. Int J Gynecol Obstet. 2013;123(2):119-23.

Torloni MR, Betrán AP, Montilla P, Scolaro E, Seuc A, Mazzoni A, et al. Do Italian women prefer cesarean section? Results from a survey on mode of delivery preferences. BMC Preg Childbirth. 2013;13(1):78.

Angeja AC, Washington AE, Vargas JE, Gomez R, Rojas I, Caughey AB. Chilean women’s preferences regarding mode of delivery: which do they prefer and why?. BJOG: An Int J Obstet Gynaecol. 2006;113(11):1253-8.

Torloni MR, Daher S, Betrán AP, Widmer M, Montilla P, Souza JP, et al. Portrayal of caesarean section in Brazilian women’s magazines: 20 year review. BMJ. 2011;342:d276.

Mi J, Liu F. Rate of caesarean section is alarming in China. Lancet. 2014;383(9927):1463-4.

De Muylder X. Caesarean section in developing countries: Some considerations. Health Policy Plan. 1993;8:101-12.

Birchard K. Defence Union suggests new approach to handling litigation costs in Ireland. Lancet. 1999;354:1710.

Barber EL, Lundsberg LS, Belanger K, Pettker CM, Funai EF, Illuzzi JL. Indications contributing to the increasing cesarean delivery rate. Obstet Gynecol. 2011;118:29-38.

Stasiełuk A, Langowicz I, Kosińska-Kaczyńska K, Pietrzak B, Wielgoś M. Is the epidemic of cesarean sections the result of more liberal indications?. Gynecol Poland. 2012;83(8):604-8.

Kolås T, Hofoss D, Daltveit AK, Nilsen ST, Henriksen T, Häger R, et al. Indications for cesarean deliveries in Norway. Am J Obstet Gynecol. 2003;188(4):864-70.

Mackenzie IZ, Cooke I, Annan B. Indications for cesarean section in a consultant unit over the decades. J Obstet Gynecol. 2003;23:233-8.

WHO. 1994. Indicators to Monitor Maternal Health Goals. Report of a Technical Working Group, Geneva, 8-12 Nov, 1993. Available at: http://apps.who.int/iris/handle/10665/60261.






Original Research Articles