A study of rate, indications and maternal morbidity associated with cesarean delivery in a tertiary care hospital


  • Asma Nigar Department of Obstetrics and Gynecology, Integral Institute of Medical Sciences and Research, Kursi Road, Lucknow, Uttar Pradesh, India
  • Ausaf Ahmad Department of Community Medicine, Integral Institute of Medical Sciences and Research, Kursi Road, Lucknow, Uttar Pradesh, India
  • Khashia Khan Department of Obstetrics and Gynecology, Integral Institute of Medical Sciences and Research, Kursi Road, Lucknow, Uttar Pradesh, India




Cesarean delivery, Cesarean rates, Indications, Maternal morbidity, Previous cesarean primary cesarean section


Background: Cesarean section is one of the most commonly performed surgical procedures in obstetrics worldwide. Over  the last three decades, a tremendous increase in cesarean section rates has been observed globally, which is a cause for concern as procedure is associated with higher morbidity and mortality compared to vaginal delivery. This study was done to analyze the rate and indications for cesarean section and associated maternal morbidity and mortality.

Methods: This retrospective study was conducted over a period of 6 months from 1st October 2017 to 31st March 2018 in the department of Obstetrics and Gynecology, Integral Institute of Medical Sciences and Research, Lucknow, India. Data of patients who were admitted for delivery in department of Obstetrics and Gynecology in OPD or emergency were recorded. Statistical analysis of various parameters namely, the cesarean section rates, its indications, the patient’s morbidity and mortality was done.

Results: The total numbers of women delivered over the study period were 577, out of which 210 patients underwent cesarean sections. The overall cesarean section rate in our study was 36.39%. Previous cesarean section was the leading indication of cesarean section (31.9%) followed by arrest of labor (18.1%), CPD (14.2%), and fetal distress (12.9%). Breech presentation (5.2%), failed induction of labor (4.8%), pregnancy induced hypertension (PIH) (3.8%), oligohydramnios (3.3%), obstructed labor (2.4%), APH (1.4%), multiple pregnancy and BOH accounted for 0.95% of cesarean sections. 9% patients had few complications mainly minor wound infection (2.4%) and postpartum hemorrhage (2%). There was no mortality during this period.

Conclusions: Previous cesarean section has been found to be the main indication for cesarean section. So primary cesarean section should be reduced to decrease the overall cesarean rates. A comprehensive, evidence based approach needs to be introduced to monitor indication of all cesarean section.


Gibbons L, Belizan JM, Lauer JA, Betran AP, Merialdi M, Althabe F. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World Health Report. 2010;30:1-31.

World Health Organization. Appropriate technology for birth. Lancet. 1985;2(8452):436-7.

Zhang J, Troendle J, Reddy UM, Laughon SK, Branch DW, Burkman R, et al. Contemporary cesarean delivery practice in the United States. Am J Obstet Gynecol. 2010;203:326.e1-e10.

Arjun G, Rajasri S, Balakrishnan S. The management of labor: Arulkumaran S, Gita Arjun, Leonie K Penna. Cesarean section procedure and technique. 3rd Ed. India universities press. 2011:248-65.

Sreevidya S, Sathiyasekaran BW. High cesarean rates in Madras (India): a population based cross sectional study. Br J Obstet Gynecol. 2003;110(2):106-11.

Mishra US, Ramanathan M. Delivery-related complications and determinants of caesarean section rates in India. Health Policy Plan. 2002;17(1):90-8.

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

Tollanes MC. Increased rate of Caesarean sections - causes and consequences. Tidsskr Nor Laegeforen. 2009;129(13):1329-31.

Barber EL, Lundsberg LS, Belanger K. Indications contributing to the increasing caesarean delivery rate. Obstet Gynecol. 2011;118(1):29-38.

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.

Das RK, Subudhi KT, Mohanty RK. The rate and indication of caesarean section in a tertiary care teaching hospital eastern India. Int J Contemp Pediatr. 2018;5(5):1733-9.

Samdal LJ, Steinsvik KR, Pun P, Dani P, Roald B, Stray-Pedersen B, et al. Indications for Cesarean Sections in Rural Nepal. J Obstet Gynaecol India. 2016;66(1):284-8.

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

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;5:3466-9.

Sarma P, Boro RC, Acharjee PS. An analysis of indications of caesarean sections at Tezpur medical college and hospital, Tezpur (a government hospital). Int J Reprod Contracept Obstet Gynecol. 2016;5:1364-7.

Patil P, Bhardwaj M, Sharma P, Chandrakar G. Changing trends in indication of cesarean section in a tertiary care centre of Central India. Int J Reprod Contracept Obstet Gynecol. 2017;6(7):2829-35.

Dasari G, Guthi VR, Bele S, Vivekannada A. A study of maternal morbidity associated with caesarean delivery in tertiary care hospital. Int J Com Med Public Health. 2017;4(5):543.

Bade P, Kendre V, Jadhav Y, Wadagale A. An analysis of indications for caesarean section at government medical college, Latur. Intern J Recent Trends Sci Technol. 2014;11(1):6-8.

Santhanalakshmi C, Gnanasekaran V, Chakravarthyet AR. A retrospective analysis of cesarean section in a tertiary care hospital. Int J Sci Res. 2013;4(9):2097-9.

Divyamol N, Raphael L, Koshy N. Caesarean section rate and its determinants in a rural area of South India. Int J Community Med Public Health. 2016;3:2836-40.

Spong CY, Lanndon MB. Risk of uterine Rupture and adverse perinatal outcome at term after caesarean delivery. Obstet Gynaecol. 2007;110(4):801-7.

Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS, et al. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ. 2007;176(4):455-60.






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