Prevalence and determinants of caesarean section in a rural tertiary teaching hospital: a 6-year retrospective study

Ke Manga Reddy, Lakshmi Sailaja P., Shiva Charana Kodimala, Poojitha Pathakamudi, Kalpana Betha


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.


Caesarean section rate, Indications, Primary caesarean section, Repeat caesarean section

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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