Prevalence and determinants of caesarean section in a rural tertiary teaching hospital: a 6-year retrospective study
Abstract
Background: Caesarean section is the most commonly performed surgery in obstetrics and there is a rise in caesarean section rates in recent times. This study was undertaken to know the changing trends in caesarean section rate in a rural hospital and to examine the indications contributing to it. The objective of the present study was to know the prevalence and changing trends in caesarean section over the last 6 years (April 2012-March 2018).
Methods: Demographic data for all the deliveries, mode of delivery and indications of caesarean sections performed from April 2012 to March 2018 that occurred at MIMS were collected in a retrospective manner.
Results: Among a total of 12,522 women delivered during the study period of 6 years, 44.93%, 48.49%, 48.41%, 50.9%, 45.48% and 49.62% were delivered by caesarean section during 2012-2013, 2013-2014, 2014-2015, 2015-2016, 2016-2017 and 2017-2018 respectively. Increase in repeat caesarean section is the primary reason for these increased rates followed by fetal distress. There is a rise in the repeat caesarean section from 44.36% in 2012-2013 to 55.67% in 2016-2017 and 47% in 2017-2018. Whereas primary caesarean section rate reduced from 55.63% in 2012-2013 to 44.32% in 2016-2017 and 53% in 2017-2018.
Conclusions: As repeat caesarean section and fetal distress are the most common causes of caesarean section we need to address these to bring down the caesarean section rate.
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Mittal S, Pardeshi S, Mayadeo N, Mane J. Trends in Caesarean Delivery : rate and indications. J Obstet Gynecol India. 2014;64(4):251-4.
Turner MJ. Delivery after one previous caesaren section. Am J Obstet gynaecol.1997;176(4):741-4.
Oladapo OT, Sotunsu JO, Sule-Odu AO. The rise in caesarean birth rate in Sagamu, Nigeria: reflection of changes in obstetrics practice. J Obstet Gynaecol. 2004;24(4):377-81.
Zizza A, Tinelli A, Malvasi A, Barbone F, Stark M, De Donno MA, et al. Caesarean section in the world :a new ecological Approach. J Prev Med Hyg. 2011;52(4):161-73.
Litorp H, Kidanto H, Nystrom L, et al. Increasing caesarean section rates among low risk groups: a panel study classifying deliveries according to Robson at a university hospital in Tanzania. BMC Pregnancy Childbirth. 2013;13(1):107.
Ray A, Jose S. Analysis of caesarean section rates according to Robson’s ten group classification system and evaluating the indications within the groups. Int J Reprod Contracept Obstet Gynecol 2017;6(2):447-51.
Agarwal M, Verma M, Garg A. Changing trends in caesarean delivery: rate and indications. Int J reprod Contracept Obstet Gynecol 2016;5(10):3522-4.
World Health Organization. Monitoring emergency obstetric care: a handbook. Geneva, Switzerland; 2009
International Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey (NFHS 1), 1992-1993. Mumbai, India:IIPS,1995
International Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey (NFHS 4), 2016-2017. Mumbai, India:IIPS,2017
Tollanes MC. Increased rate of Caesarean sections – causes and consequences. Tidsskr Nor Laegeforen. 2009;129(13):1329-31.
Villar J, Carroli G, Zavaleta N, et al: Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ 2007, 335(7628):1025-9.
Daltveit AK, Tollanes MC, Pihlstrom H, Irgens LM: Caesarean delivery and subsequent pregnancies. Obstet Gynaecol. 2008;111(6):1327-34.
Beazley JM. Caesarean section. In: Chamberlain G, Turnbull SA, editors. Obstetrics. 1st ed. Churchill Livingstone Publications; 1993. P.857-65
NotzonFC, Cnattingius S, Bergijo P, Cole S, Taffel S, Irgens L, et al. Caesarean Section delivery in the 1980s; International comparison by indication. AmJ Obstet Gynaecol. 1994;170(2):495-504.
Richman VV. Lack of local reflection of national changes in cesarean delivery rates: The Canadian experience. Am J Obstet Gynecol. 1999;180(2):393-5.
Gregory KD. Monitoring, risk adjustment and strategies to decrease caesarean rates. Curr Opin Obstet Gynecol. 2000;12(6):481- 6.
Halpern SH, Leighton BL. The risks of lowering the caesarean delivery rate. N Engl J Med 1999:341(1):54-7.
Barber EL, Lundsberg L, Belanger K, Pettker CM, Funai EF, Illuzzi JL. Indications contributing to the increasing delivery rate. Obstet Gynecol.2011;118(1):29-38.
Ba’aqeel. Caesarean delivery rates in Saudi Arabia: a ten-year review. Ann Saudi Med.2009;29(3):179-83.
Saha S, Saha S, Das R, Chakraborty M, Bala HS, Naskar P. A paradigm shift to check the increasing trend of caesarean Delivery is the need of hour: but how ? J Obstet Gynaecol India. 2012;62(4):391-7.
Choudhary AP, Dawson AJ. Trends in indications for caesarean sections over & years in a Welsh district general hospital. J Obstet Gynaecol.2009;29(8):714-7.
Stavrou EP, Ford JB, Shand AW, Morris JM, Roberts CL. Epidemiology and trends for caesarean section births in SouthWales, Australia: a population based study .BMC Preg ChildBirth 2011;11(1):8.
Litorp H, Kidanto HL, Nystrom L, Darj E, Essén B. Increasing caesarean section rates among low risk groups : a panel study classifying deliveries according to Robson at a university hospital in Tanzania. BMC Pregnancy and Childbirth 2013,13(1):107.
Guise JM, Berlin M, McDonagh M, Osterweil P, Chan B, Helfand M. Safety of vaginal birth after caesarean: A systematic review. Obstet Gynaecol. 2004;103(3):420-9.
National Institutes of Health Consensus Development Conference Statement. Vaginal birth Caesarean: new insights March 8-10;115(6):1279-95
McMahon MJ, Luther ER, Bowles WA Jr, Olshan AF. Comparison of trial of labour with an Elective caesarean section. N Engl J Med. 1996; 335(10);689-90.
Anderson GM, Lomas J. Determinants of increased caesarean birth rate. Ontario data 1979-82. N Engl J Med. 1984:311(14):887-92.
Begum T, Rahman A, Nababan H, Hoque DM, Khan AF, Ali T, et al. Indications and determinants of caesarean section delivery: Evidence from a population-based study in Matlab, Bangladesh. PloS one. 2017;12(11):e0188074.
Mandatory Second Opinion to reduce Unnecessary C- Sections: WHO 2018 Guidelines. Available at https://speciality.medicaldialogues.in/have-mandatory-second-opinion-to-reduce-unnecessary-c-sections-who-2018-guidelines/.