Factors Leading to Increased Cesarean Section Rate

Background: There is public health concern about increasing cesarean section rate. This study was conducted to evaluate cesarean section rate in our set-up. Material & Methods: It was descriptive study carried out in Gynae B unit, Ayub Teaching Hospital, Abbottabad, from January 2006 to December 2007. Patients who underwent cesarean section were included. Details of age, social status, parity, antenatal booking, onset of labor, prior intervention, reason for referral and fetal condition were explored. Results: During study period 2934 deliveries occurred with cesarean section in 1325(45.1%); elective 412(31%) and emergency 913(68.9%). Antenatal booking was done in 67(5%). Education level of mothers was primary level in 94 (7%). Maternal age ranged 20-45 years. Social status was poor in 860(65%) and lower middle class in 465(35%). Regarding parity, primigravida were 492(37.1%), multigravida 560(42%) and grand multigravida 273(20.6%). Distance of referral areas ranged 10-270 kilometers. First level care providers were Daies 495(37.3%), Lady Health Workers 335(25.2%), General Practioners 229(17.2%) and no care 270(20.3%). Prior intervention included oxytocin infusions 599(45.2%), prostaglandins 245(18.4%), instrumentation 53(4%) and no intervention 430(32.4%). Indication for cesarean was repeat cesarean 282(20.5%), obstructed labor 257(19.3%), fetal distress 191(14.4%), failure to progress 159(12%), breech presentation 136(10.2%), hypertensive disorders 136(10.2%), antepartum hemorrhage 91(6.8%) and post date pregnancy 47(3.5%). Conclusion: Cesarean section rate is quite high (45%) in indigent population in our set up. The low level skill of primary care providers and injudicious use of oxytocics are the main factors responsible for this high rate.