Record based analysis of indications and complications of 500 cases of lower segment cesarean sections at a tertiary care hospital

Vaishali Chaurasia; Sushruta Shrivastava

doi:10.18203/2320-1770.ijrcog20190003

Authors

Vaishali Chaurasia Department of Obstetrics and Gynecology, Sultania Zanana Hospital, GMC, Bhopal, Madhya Pradesh, India
Sushruta Shrivastava Department of Obstetrics and Gynecology, Sultania Zanana Hospital, GMC, Bhopal, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20190003

Keywords:

Caesarean section, Indication of caesarean section, Maternal morbidity

Abstract

Background: The drastically increasing rate of caesarean section is a topic of constant worry and analysis throughout the world. In order to understand the degree to which caesarean section may be preventable, it is important to know why caesarean section are performed. This study is aimed to find out the rate of caesarean section at our institute, various indications of the procedure and complications related to them.

Methods: This study was carried out retrospectively in the department of obstetrics and gynecology at Chirayu Medical College and Hospital, Bhopal. Study period was from January 2017 to December 2017. 500 cases of lower segment cesarean section were studied including both elective and emergency caesarean sections. Statistical analysis of age, parity, period of gestation, indications of LSCS and complications was done.

Results: The rate of caesarean section came out to be 47.7%, which is far above recommended. Majority of patients (81.6%) were in 21-30 years age group; while the number of primary and repeat caesarean section were comparable (40.8% and 59.2%respectively). Commonest indication was previous LSCS (31.6%) followed by fetal distress (21.6%). Surgical site infection was present in 4.6% cases whereas, post-partum hemorrhage occurred in 5.8% cases. Three patients underwent obstetric hysterectomy and two cases of maternal mortality were reported among post LSCS patients.

Conclusions: Increasing rates of caesarean section has contributed to maternal morbidity along with financial burden. Individualization of the indication and careful evaluation, following standardized guidelines, practice of evidenced-based obstetrics and audits in the institution, can help us limit rate of caesarean section.

Metrics

Metrics Loading ...

References

WHO statement on caesarean section rates. Available at: http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/.

Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, et al. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Global Health. 2015;3(5):e260-70.

Ye J, Betrán AP, Guerrero Vela M, Souza JP, Zhang J. Searching for the optimal rate of medically necessary cesarean delivery. Birth. 2014;41(3):237-44.

Lumbiganon P, Laopaiboon M, Gülmezoglu AM, Souza JP, Taneepanichskul S, Ruyan P, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08. Lancet. 2010;375(9713):490-9.

Villar J, Carroli G, Zavaleta N, Donner A, Wojdyla D, Faundes A, et al. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ. 2007;335(7628):1025.

Souza JP, Gülmezoglu AM, Lumbiganon P, Laopaiboon M, Carroli G, Fawole B, et al. Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health. BMC Med. 2010;8(1):71.

Gibbons L, Belizan JM, Lauer JA, Betran AP, Merialdi M, Althabe F. Inequities in the use of cesarean section deliveries in the world. Am J Obstet Gynecol. 2012;206(4):331-e1.

Stanton C, Ronsmans C, Baltimore Group on Cesarean. Recommendations for routine reporting on indications for cesarean delivery in developing countries. Birth. 2008;35(3):204-11.

Torloni MR, Betran AP, Souza JP, Widmer M, Allen T, Gulmezoglu M, et al. Classifications for cesarean section: a systematic review. PloS One. 2011;6(1):e14566.

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

Betran AP, Vindevoghel N, Souza JP, Guelmezoglu AM, Torloni MR. A systematic review of the Robson classification for caesarean section: what works, doesn't work and how to improve it. PloS One. 2014;9(6):e97769.

Jawa A, Garg S, Tater A, Sharma U. Indications and rates of lower segment caesarean section at tertiary care hospital-an analytical study. Int J Reprod Contracept Obstet Gynecol. 2016;5(10):3466-9.

Gupta M, Garg V. The rate and indications of caesarean section in a tertiary care hospital at Jaipur, India. Int J Reprod Contracept Obstet Gynecol. 2017;6(5):1786-92.

Mittal S, Pardeshi S, Mayadeo N, Mane J. Trends in cesarean delivery: rate and indications. J Obstet Gynecol India. 2014;64(4):251-4.

Liu Y, Li G, Chen Y, Wang X, Ruan Y, Zou L, et al. A descriptive analysis of the indications for caesarean section in mainland China. BMC Preg Childbirth. 2014;14(1):410.

Treffers PE, Pel M. The rising trend for caesarean birth. BMJ: Brit Med J. 1993;307(6911):1017.

Nikhil A. Analysis of Trends in LSCS Rate and Indications of LSCS-A Study in a Medical College Hospital GMERS, Sola, Ahmedabad. Int J Pharm Bio-Scienc. 2015;2(1).

Pandya JM, Pandya MJ, Joshi JM, Velani SP. Analytical study of indications of cesarean section. Int J Reprod Contracept Obstet Gynecol. 2017;4(5):1460-3.

Thomas J, Paranjothy S. Royal College of Obstetrics and Gynaecology Clinic Effectiveness Support Unit. National Sentinel Caesarean Section Audit Report.

Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP. Risk of uterine rupture during labor among women with a prior cesarean delivery. New England J Med. 2001;345(1):3-8.

Mozurkewich EL, Hutton EK. Elective repeat cesarean delivery versus trial of labor: a meta-analysis of the literature from 1989 to 1999. Am J Obstet Gynecol. 2000;183(5):1187-97.

Rageth JC, Juzi C, Grossenbacher H. Delivery after previous cesarean: a risk evaluation. Obstet Gynecol.1999;93(3):332-7.

Nikhil A. Analysis of Trends in LSCS Rate and Indications of LSCS-A Study in a Medical College Hospital GMERS, Sola, Ahmedabad. Int J Pharm Bio-Sci. 2015;2(1).

Gielchinsky Y, Rojansky N, Fasouliotis SJ, Ezra Y. Placenta accreta-summary of 10 years: a survey of 310 cases. Placenta. 2002;23(2):210-4.

Nizam K, Haider G, Memon N, Haider A. Cesarean section rate: much room for reduction. Rawal Med J. 2010;35:19-22.

Chavda D, Goswam K, Dudhrejiya K. A cross sectional study of 1000 lower segment cesarean section in obstetrics and gynecology department of PD U Medical College, Rajkot, Gujarat, India. Int J Reprod Contracept Obstet Gynecol. 2017;6(4):1186-91.