Analytical study on indications of primary cesarean section in tertiary care hospital


  • Arpitha S. Ballu Department of Obstetrics and Gynecology, Mysore Medical College and Research Institute, Mysore, Karnataka, India
  • Asha M. B. Department of Obstetrics and Gynecology, Mysore Medical College and Research Institute, Mysore, Karnataka, India



Cesarean section, Fetal, Maternal, Primary


Background: Cesarean delivery is a commonest obstetric surgical procedure performed. WHO stated that regional cesarean section rate should not exceed 10 to 15%. However in many countries cesarean delivery has increased steadily over years. Hence present study is conducted to analyze various indications of primary cesarean section in a tertiary hospital, with an aim to reduce cesarean section rate.

Methods: This is a retrospective study conducted in Cheluvamba hospital, Mysore Medical College Research Institute, Mysore, which is a tertiary care centre. For a period of 6months from 1st June 2018 to 31st November 2018

Inclusion criteria: All primary cesarean section done at Cheluvamba hospital during study period were included.

Exclusion criteria: Previous cesarean section, patients with previous history of laparotomy done for any obstetric or gynecological cause were excluded.

Results: During the study period there was 3799 number of cesarean section. Amongst these 983 cases were primary cesarean section done for varying indications. Hence the rate of cesarean section in our hospital is 25.87%. There were 40.3% cases of fetal distress, failed induction (13.6%), breech (10%), CPD (8%), IUGR with poor BPP (1.8%) Ante partum haemorrhage (3%), DTA (3.5%).

Conclusions: From our study, we would conclude that rising trend in cesarean section is an alarming issue. Measures need to be taken to reduce cesarean delivery like Regular use of partograph, Judicious use of amniotomy, oxytocin with inducing agents, Expertization of skills to conduct instrumental vaginal delivery, which is a lost art in modern obstetrics.


Malhotra N, Puri R, Malhotra J, Kurjak A, Chervenak FA. Donald School Manual of Practical Problems in Obstetrics. 1st ed. JP Medical Ltd; 2012.

John Patrick o’Grady, Timothy K. Fitzpatrick, Martin L. Gimovsky, Locy. Bager-Zwirello. Kevin Giordano, Operative obstetrics. Cesarean delivery and Surgical Sterilization, Chapter 18, 2nd Ed. 509.

WHO-Appropriate technology for birth. Lancet 1985; 2:436-7.

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.

National family health survey (NFHS-4) 2012-14. Mumbai: International institute for population sciences (IIPS) and Macro International; 2009. Available at: 4.shtml (cital 2014 december 2018).

Thomas J, Paranjothy S. RCOG Clinical Effectiveness Support Unit. The National Sentinel Caesarean Section Audit Report. RCOG Press; 2001:49-53.

William obstetrics, “Cesarean Delivery.” 24th edition;588, F.Gary Cunningham, Kenneth J Leveno, Steven L.Bloom, Catherine.Y.Spong, Jodi.S.Dasha.

Cesarean section, 7th edition;571, Renu Mishra, Nupur Guptha, Ian Donald.

Barber EL, Lundsberg LS, Belanger K, Pettker CM, Funai EF, Illuzzi JL. Indications contributing to the increasing cesarean delivery rate. Obstet Gynecol. 2011;118(1):29-38.

Dr. R C Prameela, Dr. Asma Farah, Dr. Bhanumati, S. Prajwal, "Analysis of cesarean section rate in a tertiary hospital, according to Robson's 10 group classification system (TGCS)". IOSR-JDMS. 2015;14(2):46-49.

Samal R, Palai P, Ghose S. Clinical study of primary caesarean section in multiparous women in a tertiary care hospital. International J Reprod, Contracept, Obstet Gynecol.;5(5):1507. www.ijrcog.orgl

Reena Sharma, poojan dogra. International J Reproduct, Contracept, Obstet Gynecol. 2017;6(10):4367-4371

Onankpa B, Ekele B. Fetal outcome following cesarean section in university teaching hospital. J Natl Med Assoc. 2009;101:578-81.

Rouse DJ, Owen J, Goldenberg RL, Cliver SP. The effectiveness and costs of elective cesarean delivery for fetal macrosomia diagnosed by ultrasound. JAMA. 1996;276(18):1480-6.

Friedman E. An objective approach to the diagnosis and management of abnormal labor. Bull N Y Acad Med 48:842.

Heinemann J, Gillen G, Sanchez-Ramos L, Kaunitz AM. Do mechanical methods of cervical ripening increase infectious morbidity? A systematic review. Am J Obstet Gynecol. 2008;199(2):177-88.

Gabbe SG, Landen MB, Nichyl JR, Galon HL, Simpson JL. Obstetrics normal and problem pregnancies. Operative Vaginal Delivery, Chapter 15, 6th Ed: 302.






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