Changing trends in caesarean deliveries at a tertiary care centre: a ten year appraisal
Abstract
Introduction: Over the last few decades, the rise in the rates of Caesarean Sections (CS) has become a global phenomenon. The objective of this study was to follow the CS rates over the last 10 years and to compute the various indications of CS in an attempt to analyze the possible reasons for this changing trend in the institute.Methods: All deliveries that took place between April 13 2004 to April 14 2014 (Baisakh 2061 BS and Chaitra 2070 BS) in TUTH were retrospectively collected. Annual total number of deliveries, rates of CS, instrumental deliveries and Vaginal Birth after Caesarian Section (VBAC) along with indications for CS were computed and analyzed.Result: A total of 38,770 deliveries were conducted over ten years with 26,791 (69.10%) vaginal deliveries and 11,979 (24.80%) CS. There was a steep rise in the rates of CS from 21.04% in 2004 to 39.23% in 2014. Rates of instrumental deliveries and VBAC remained low at 0.86% to 3.35% and 0.15% to 0.7 % respectively. Fetal distress was the commonest indication of emergency CS while previous CS was the commonest indication for elective CS.Conclusion: Over the last decade, the global trend of rising CS rates was also found to be mirrored at TUTH. The causes for rise in CS rates were- increased diagnosis of fetal distress and oligohydramnios, delivery of most breech by Caesarean sections, low rates of VBAC and instrumental deliveries, complicated referrals from all over the country and last but not the least, threat of malpractice litigations.References
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2. World Health Organization. Appropriate Technology for Birth. Lancet 1985; 326(8452): 436-7.
3. World Health Organization. Indicators to Monitor Maternal Health Goals: Report of a Technical Working Group. WHO/F; 1994
4. Hamilton BE, Martin JA, Ventura SJ. Births: preliminary data for 2011. Natl Vital Stat Rep 2012;61(5):1-19
5. Caesarian Section Delivery, an increasingly popular option. Bulletin of the World Health Organization (WHO). October 2001; 79(12)
6. Chhetri S, Singh U. Caesarean section: its rates and indications at a tertiary referral center in Eastern Nepal. N J Obstet Gynaecol.2011 Sep-Dec; 9(3):179-83.
7. Editorial: What is the right number of caesarean sections? Lancet 1997;349:815-6.
8. Peskin EG, Reine GM. A guest editorial: What is the correct caesarean rate and how do we get there? Obstetrical and Gynecological Survey 2002;57:189-90.
9. Wagner M. Choosing caesarean section. Lancet 2000;356:1677-80.
10. Thomas J, Paranjothy S. Royal College of Obstetricians and Gynaecologists Clinical Effectiveness Support Unit. The National Sentinel Caesarean Section Audit Report. London, United Kingdom: RCOG Press, 2001.
11. National Collaborating Centre for Women's and Children's Health. Caesarean Section: Clinical Guideline. London, United Kingdom: RCOG Press, 2004.
12. Clarke SC, Tafel S. Changes in caesarean delivery in the United States, 1988 and 1993. Birth 1995; 22:63-7.
13. Upadhyay N, Buist R, Steer P. Caesarean section: an evolving procedure? British Journal of Obstetrics and Gynaecology 1999; 106: 286-7.
14. Treffers PE, Pel M.The rising trends for caesarean birth. BMJ 1993; 307: 1017-8
15. Royal College of Obstetrician and gynecologist. The national sentinel caesarean section audit report RCOG clinical effectiveness support unit London, RCOG press, 2001.
16. Thacker SB, Stroud DF & Peterson HB. Efficacy and safety of intrapartum electronic fetal heart rate monitoring: an update. Obstetrics and Gynecology 1995; 86: 613-20.
17. Vintzileos AM, Nochimson DJ, Guzman ER. Intrapartum electronic fetal heart monitoring versus intermittent auscultation: a metaanalysis. Obstetrics and Gynecology 1995; 85: 149-55.
18. McMahon MJ, Luther ER, Bowes WA. Comparison of trial of labour with an elective second caesarean section.New England Journal of Medicine 1996; 335: 689-95.
19. Flamm BL, Goings JR, Liu Y. Elective repeat caesarean section versus trial of labour: a prospective multicenter study. Obstetrics and Gynecology 1994; 83: 927-32.
20. Dickinson JE. Previous caesarean section. In: James DK, Steer PJ, Weiner CP, Gonik B, editors. High Risk Pregnancy: Management Option. 2nd edition. London: W.B. Saunder; 1999;1205-16.
21. Maskey S. Obstetric Referrals to a Tertiary Teaching Hospital of Nepal. N J Obstet Gynecol 2015 Jan-Jun; 19 (1):52-6.
Published
2016-08-02
How to Cite
PAUDYAL, Pooja.
Changing trends in caesarean deliveries at a tertiary care centre: a ten year appraisal.
J Soc Surg Nep, [S.l.], v. 17, n. 2, p. 7-11, aug. 2016.
ISSN 2392-4772.
Available at: <https://jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=164>. Date accessed: 23 oct. 2024.
Issue
Section
Original Article
Keywords
Caesarean sections; rates; indications
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