Open Access Subscription Access
Increasing Caesarean Rates: Analysis of Indications and Possible Interventions
Background: The alarming increase in caesarean section rates worldwide has led to a shift of focus to caesarean section rates and indications for caesarean section. The main objective of the study was to analyse the indications for caesarean section with the aim of finding viable interventions which could help decrease the caesarean rates. Methods: A retrospective study from 1st January 2017 to 31st December 2017 was conducted in which we analysed patient records of those delivering in unit III of our institute. Analysis of patient records was done and indication for caesarean was analysed. Results: A total of 496 women delivered in our unit in 2017, of these, 303 (61.09%) had a vaginal delivery and 193 (38.91%) had caesarean section. 108 patients (21.77%) had a history of at least one previous caesarean section and of these 94 (87.03%) underwent a repeat caesarean section. The primary caesarean section rate was 25.51%. Section was done for breech presentation in eleven primigravidae (5.7% of sections) and in fifteen multigravidae (7.77% of sections) including those with a previous section. Four patients had multiple pregnancy (2.04% of all sections). Eleven patients had a preterm section (5.7% of sections). Conclusion: In order to decrease caesarean rates the group that requires most focus is those in whom a primary section is being done. Few patients who have undergone at least one prior surgery are willing to take the risk inherent to a trial of labour (TOLAC). Classification and reporting of caesarean section according to the Robson ten point criteria will help in a better understanding of the indication, comparison and auditing and help to establish guidelines that can help decrease the caesarean rates.
Caesarean Section, Classification, Labour, Pregnancy, Primary.
- Robson Classification: Implementation Manual. Geneva: World Health Organization; 2017
- WHO Statement on Caesarean Section Rates. Geneva: World Health Organization; 2015 (WHO/RHR/15.02).
- Spong CY, et al. Preventing the first cesarean delivery: Summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development. Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol. 2012 Nov; 120(5):1181–93. PMid:23090537 PMCid:PMC3548444
- Radhakrishnan T, et al. Increasing trend of caesarean rates in India: Evidence from NFHS-4. JMSCR. 2017 Aug; 5(8).
- NFHS-4. Clinical Anthropometric Biochemical (CAB) manual.
- Gainder S, et al. Reducing cesarean section rate: are obstetric audits useful? Report from a Tertiary Referral Hospital of India. Imperial Journal of Interdisciplinary Research (IJIR). 2017; 3(10).
- Gupta M, et al. The rate and indications of caesarean section in a tertiary care hospital at Jaipur, India. Int J Reprod Contracept Obstet Gynecol. 2017 May; 6(5):1786–92 https://doi.org/10.18203/2320-1770.ijrcog20171530
- Sharmila G, Nishitha Ch. Study of primary caesarean section in multigravida. Asian Pac J Health Sci. 2016; 3(4):89–94. https://doi.org/10.21276/apjhs.2016.3.4.14
Abstract Views: 39
PDF Views: 13