Caesarean Section: A Necessary Evil?
Keywords:
Andaman and Nicobar, CS Rate, Intra-Operative Complications, Indications of CS, Post-Operative ComplicationsAbstract
Background: Caesarean Section (CS) has become more prevalent over the years due to various factors and is exceeding the specified limit laid down by the WHO. Caesarean section is associated with various maternal and neonatal morbidities. With the alarming rise in Caesarean Section rate, these complications invariably increase. We conducted this study to assess the maternal and neonatal morbidities associated with CS in a tertiary care hospital in Andaman and Nicobar Islands, India.
Methods: This was a prospective observational study done over a period of one year from January 2018 to December 2018. Data was collected for all CS performed in this time period and was statistically analysed by MS Excel, frequency distribution tables and SPSS Software.
Result: Over the study period of one year, there were total 2646 deliveries with caesarean rate of 38.51% and more than 75% of these were primary caesarean section. Almost three fourth (73.61%) were emergency CS. Intraoperative adhesions and extension of uterine incision were common intraoperative complications whereas PPH was the most common post-operative morbidity. Intra operative complications were more in cases of emergency CS.
Conclusion: We found a high CS rate with a high percentage of primary caesarean section along with various complications. With advancement in better maternal and foetal monitoring in labour in a tertiary care centre, it is desirable to be able to provide a safer vaginal delivery to patients that promises a better obstetric future. The decision to perform a Caesarean delivery must be chosen carefully, balancing risks and benefits, and not liberally. This is only possible if standard guidelines and protocols of management are in place at national and institutional levels. Only then the overall primary CS rate and its complications can best be avoided.
References
WHO Statement on caesarean section rates. 2015. WHO reference number: WHO/RHR/15.02. Available from:
http://www.who.int/reproductivehealth/publications/maternal perinatal health/cs-statement/en.
National vital statistics report. 2012; 62(9). Available from: https://www.cdc.gov/nchs/products/nvsr.htm.
WHO Euro Health for all database, 2014. Available from: http://data.euro.who.int/hfadb/(53).
International Institute for Population Sciences (IIPS) and ICF. 2017. National Family Health Survey (NFHS-4),
-16: India. IIPS, Mumbai. Available from: http://rchiips.org/NFHS/NFHS4Reports/India.pdf.
American College of Obstetricians and Gynaecologists. Safe prevention of the primary cesarean delivery.
Obstetric Care Consensus No. 1. Obstet Gynaecol 2014; 123: 693-711.
Royal College of Obstetricians and Gynaecologists. Reducing the risk of venous thromboembolism during
pregnancy and the puerperium. Green-top Guideline 37a. 2015.
Levine EM, Ghai V, Barton JJ et al. Mode of delivery and the risk for respiratory diseases in new-borns. Obstet
Gynecol 2001; 97(3): 439-442.
Gregory KD, Jackson S, Korst L et al. Cesarean versus vaginal delivery: Whose risks? Whose benefits? Am J
Perinatol 2012; 29(1): 7-18.
Subhashini R, Uma N. Changing trends in Caesarean delivery. IAIM 2015; 2(3): 96-102.
Jawa A, Garg S, Tater A et al. Indications and rates of lower segment caesarean section at tertiary care
hospital-an analytical study. Int J Reprod Contracept Obstet Gynecol 2016; 5(10): 3466-3469.
Preetkamal, Kaur H, Nagpal M. Is current rising trend of cesarean sections justified? Int J Reprod Contracept
Obstet Gynecol 2017; 6(3): 872-876.
Das RK, Trimal Subudhi K, Mohanty RK. The rate and indication of caesarean section in a tertiary careteaching hospital eastern India. International Journal of Contemporary Pediatrics 2018; 5(5): 1733-1739.
Singh G, Gupta ED. Rising incidence of caesarean section in rural area in Haryana, India: a retrospective analysis. Internet J Gynecol Obstet 2013; 17(2): 1-5.
Stanton C, Ronsmans C. Recommendations for routine reporting on indications for caesarean delivery in
developing countries. Birth 2008; 35(3): 204-211.
Torloni MR, Betran AP, Souza JP et al. Classification for caesarean section: a systematic review. PLoS One
; 6: e1456.
Desai E, Leuva H, Leuva B et al. A study of primary caesarean section in multipara. Int J Reprod Contracept
Obstet Gynecol 2013; 2(3): 320-324.
Jain M, Patel A. A cross sectional study of rate, indications and complications of primary caesarean
section. Int J Reprod Contracept Obstet Gynecol 2016; 5(6): 1814-1819.
Sarma P, Boro RC, Acharjee PS. An analysis of indications of caesarean sections at Tezpur medical college and
hospital, Tezpur (a government hospital). Int J Reprod Contracept Obstet Gynecol 2016; 5: 1364-1367.
Chavda D, Goswami K, Dudhrejiva K. A cross sectional study of 1000 lower segment cesarean section in
obstetrics and gynecology department of P. D. U Medical College, Rajkot, Gujarat, India. Int J Reprod
Contracept Obstet Gynecol 2017; 6(4): 1186-1191.
Nikhil A, Desai A, Vijay K, et al. Analysis of trends in LSCS rate and indications of LSCS: a study in a Medical
College Hospital GMERS, Sola, Ahmedabad. Int J Pharm Bio-Sci 2015; 2(1): 1-5.
Bade P, Kendre V, Jadhav Y et al. An analysis of indications for caesarean section at government medical college, Latur. Intern J Recent Trends Sci Technol 2014; 11(1): 6-8.
Magann EF, Evans S, Hutchinson M et al. Postprtum hemorrhage after cesarean delivery: an analysis of risk
factors. South Med J 2005; 98(7): 681-685.
Kumar N. Postpartum Hemorrhage; a Major Killer of Woman: Review of Current Scenario. Obstet Gynecol
Int J 2016; 4(4): 00116.
Santhanalakshmi C, Gnanasekaran V, Chakravarthy AR. A retrospective analysis of cesarean section in a
tertiary care hospital. Int J Sci Res 2015; 4: 2097-2099.
Hansen AK, Wisborg K, Uldbjerg N et al. Elective caesarean section and respiratory morbidity in the
term and near-term neonate. Acta Obstetricia et Gynecologica 2007; 86: 389-394.
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