FREQUENCY AND INDICATIONS OF CESAREAN SECTION IN A TERTIARY CARE HOSPITAL OF PESHAWAR, KHYBER PAKHTUNKHWA, PAKISTAN

Abstract

Introduction:  There are no preset criteria for standardizing Cesarean Section (C-section) practices and rates on a global level, despite many attempts to reduce or rationalize the Cesarean Section Rate (CSR). The present study was conducted to determine the frequency and indications of Cesarean Section in a tertiary care hospital, the Rehman Medical Institute, located in Peshawar, Khyber Pakhtunkhwa, Pakistan.

Materials & Methods: This Descriptive study was conducted in Obstetrics and Gynecology Department of Rehman Medical Institute, Peshawar from June 01, 2015 to Dec 31, 2015. In this study, clinical records of all the pregnant women who underwent C-section during this period were analyzed including patients booked in antenatal clinic and unbooked patients in early labor on whom Cesarean Section was performed. Patients with previous classical Cesarean Section and uterine rupture were excluded from the study. The data were analyzed on SPSS version 15.0.

Results: During the 6 months study period, 859 patients were delivered, of whom 378 underwent Cesarean Section and 481 patients had vaginal delivery. Hence the Cesarean Section rate (CSR) was 44%. Ages of C-section patients ranged from 16-44 years, with mean age of 28.2 ± 4.96 years. Of all 378 patients, 206(54.49%) were booked for Cesarean Section while 172(45.5%) were emergency referral cases.  Considering Parity, 154(40.7%) were Primigravida, 186(49.2%) were Multigravida and 38(10.05%) were Grand multigravida.

The commonest indications for Cesarean Section were Repeat C-section in 174(46.03%) and fetal distress in 57(15.07%) patients. There were 92(23.5%) patients with previous 01 C-section, 60(15.3%) patients with previous 02 C-sections, 23(5.9%) with previous 03 C-sections and 01 patient with previous 04 C-sections. Patients with more than 02 C-sections directly underwent C-section either in emergency or planned.

Conclusion: There is still much room for reducing the frequency of Cesarean Sections. Rising first birth Cesarean rate drove the overall increase and caused further feeds into repeat Cesareans.