ANALYSIS OF URGENCY, GESTATIONAL AGE AND CONTRIBUTING FACTORS FOR INCREASING CAESAREAN SECTION RATES

Abstract

Background: Over the past few decades, the indications for Caesarean delivery have broadened thus increasing the rate of caesarean section beyond the set level of WHO. The indications vary in different health care facilities. It is essential to determine the factors responsible for increasing caesarean section rates. To Objectives: nd out the cesarean section rate based on urgency as per RCOG and gestational age as per the categorization of pregnancy by ACOG in a tertiary health care facility catering to large South Indian population. It also aimed to determine the associated conditions contributing for caesarean section. Retrospective analysis of women who underwent caesar Methods: ean section from Jan-2017 to June 2017. Data was analyzed with respect to gestational age, Urgency of caesarean section, maternal fetal indications, clinical characteristics and associated conditions. Neonatal outcomes measured were gestational age, birth weight and NICU admissions. Data was expressed as proportions and percentages. The CS Results: rate was 24.5% among7, 346 deliveries and 81% were emergency CS. Preterm Caesarean sections were done in 18% and term 81.5%. Category II CS were the commonest (49%) followed by Category I (32%). Scarred uterus was the most common indication (85%) for elective caesarean section and fetal distress was most common indication (55.7%) for emergency caesarean sections. The associated factors were prior Caesarean section (32%), Medical disorders in 21% and 2.4% prolonged infertility and ART conceptions. Obstetric conditions including mal presentation were responsible in 19%. On the whole fetal indications accounted for 62%. Conclusion: Fetal indications, especially fetal distress is the most common reason for caesarean section which may have contributed for increased rate of caesarean section. Hence following strict criteria for diagnosis of fetal distress and adopting policies for intrauterine resuscitation prior to decision making for cesarean section would contribute to reduction of CS rate at tertiary health care centers.