Indications of cesarean section in a tertiary care hospital in delhi

Introduction: Cesarean rates have almost doubled globally from 12% in year 2000 to 21% in 2015. Around 10-15% pregnant women need cesarean section (CS) which can be life saving for both mother and baby. Scientific, social, cultural and medico-legal reasons are seen to be the reason behind this increase in CS. Besides being life- saving, CS also lowers the future risk of incontinence and prolapse in women. As compared to vaginal birth, maternal mortality and maternal morbidity is higher after CS. In pregnancies after CS there is dose dependent increase in risk of uterine rupture, abnormal placentation, ectopic pregnancy, stillbirth and preterm birth. Babies born via C-section have been found to have different hormonal, physical, bacterial and medical exposures during birth, which can subtly alter their health. Common indications for CS are fetal distress, malpresentations, cephalon-pelvic disproportion, non-progress of labor, hypertensive disease and antepartum hemorrhage. Rates of cesarean have increased because the procedure has become safer there is an increase in offering and acceptance of this surgery. Beside this, there is a decrease in VBAC trial, operative vaginal deliveries (Forceps/Ventouse) and threshold of patients for bearing labor pains and there is increase in litigations, electronic monitoring, decreasing and cesarean on maternal request.
So there is need to study indications and their weight age in contribution to this procedure.
Material and methods: This retrospective observational study was done in Deptt. of Obs and Gynae in NDMC Medical College & Hindu Rao Hospital. Case records of 140 patients who underwent cesarean section from November 2018 to January 2019 were reviewed.
Results: Current cesarean rate in our hospital is 22%. Previous cesarean was the commonest reason seen in 43% cases. CPD, fetal distress and malpresentations were the common cause of cesarean and together contributed to half of all the indications. Failed IOL accounted for 10% of all the cesareans. Cesarean done on maternal request was 5% and its contribution to cesarean section was almost same as severe preeclampsia, non- progress of labor, decrease fetal movement and severe oligohydramnios with or without fetal growth restriction. There were 2 cases with cord around neck as indication for CS.
Discussion: The routine indications for cesarean section like previous CS, CPD, malpresentation, fetal distress, failed induction of labor are comparable to other studies. CSMR contributed to 5% of all cesareans and cord around neck was an indication in 2 cases which was not reported by previous studies.
Conclusion: The decision to do a cesarean section should be individualised so that it is done timely in a needy patient and unnecessary cesarean sections are avoided. In modern era of safe obstetrics, cesarean on maternal request and cord around the neck have emerged as newer indications for cesarean section. Besides educational interventions for women, audit of cesarean sections and timely feed back to health professionals about indications for cesarean section should be routinely done.