A cross sectional study of rate, indications and complications of primary caesarean section

Background: The indications for cesarean sections have been undergoing a gradual change over the last few decades. Besides the obstetric causes, several other medical, social, ethical, economic and medico legal factors play a role in this rising trend of cesarean section. Initially it was performed mainly for maternal interest but recently the health of the fetus has played a significant role in making the decision for a cesarean birth. This study was conducted to determine the rate, indications and complications of primary cesarean section in primi and multiparae. Methods: This was a cross sectional study carried out on primary cesarean section in the Department of Obstetrics and Gynecology, P.D.U. Medical College and Hospital, Rajkot during one year period from April 1, 2014 to March 31, 2015. During this study, patients (booked or unbooked) attending the labour room, undergoing primary cesarean section in the department will be selected according to the inclusion criteria. Their intraoperative and postoperative complications would be noted and also maternal and fetal morbidities and complications if any. The study does not include women who had Gestational age of less than 28 weeks, who underwent cesarean section in previous pregnancy, previous uterine surgery or hysterotomy and who had multiple gestations. Results: Out of 7295 deliveries performed during one year period, overall 1349 CS were performed with an incidence of 18.5%. The frequency of primary cesarean section was higher in primipara (72.4%) than multipara (27.6%) women. Emergency cesarean section (79.3%) was performed more than elective cesarean section (20.7%) in both the study group and most of them, did not taken ANC. 28.5% of the patients were unbooked and 46.6% of the patients were referred. Illiteracy was present in 31.7% cases and 62.6% cases belonged to rural areas. Anemia, malpresentations, oligohydramnios, eclampsia and preeclampsia were more common antenatal complications in primipara patients than multipara patients, while APH was more common complication in multiparity. In unbooked patients, anemia was found more commonly. Malpresentation (34.3%) was the commonest indication for cesarean sections in both the study groups. Intraoperative complications like extension of uterine incision, placenta praevia, PPH were found more in caesarean section done in emergency than electively and more in multipara patients. Maternal morbidity was seen in 18.5% of cases and more in multipara (25.4%) than primipara (15.9%). Abdominal distension, wound gap and fever were the common morbidities while no maternal mortality in the present study. 330 out of 685 babies were admitted in NICU and majority of them were for jaundice, preterm care and birth asphyxia. Perinatal mortality in the study was 6.6% and among them antepartum hemorrhage has the highest perinatal mortality rate. Prematurity was the most common cause of neonatal deaths. Conclusions: From this tudy, we concluded that overall CS rate is 18.5% and rate of vaginal delivery is 82.1% of the present study from 1st April 2014 to 31st March 2015. While primary cesarean section rate is 55.8%, more in primipara as compared to multipara. The malpresentation was the major indication in primary cesarean section, in both primipara and multipara women in our community, while APH is still a major problem of the multiparity. Anemia, malpresentation, eclampsia and preeclampsia were more common antenatal complications in primipara while APH was antenatal complication in multiparity. Malpresentation (34.3%) was the commonest indication for cesarean section in both the groups.