An Audit of the Increasing Caesarean rate in a teaching hospital

Aim: To evaluate the current caesarean section rate in a Sir Ganga Ram hospital, so as to determine the impact of increasing caesarean section rate on maternal and fetal morbidity and to reevaluate the indications of caesarean section. Design: It is descriptive observational study carried out at Sir Ganga Ram Hospital Lahore from 1st January to 31st December 2013 (A3 years study). Methods: All patients undergoing emergency and elective caesarean section in Sir Ganga Ram Hospital Lahore were included in this study during the said period. Their demographic characteristics were recorded including; maternal age, parity, gestational age at presentation, medical history and indication of previous caesarean section,. Details of antenatal care, history of labour; any intervention (prostaglandins/oxytocin, vaccum/outlet forceps) and reason of referral if any. The maternal and fetal outcome was also recorded in terms of maternal and neonatal hospital ICU admission and stay. Results: A total of 1,14158 patients were admitted in Obstetric & Gynae department of Sir Ganga Ram Hospital during this 3 years study period and total no. of deliveries in the same period were 56026 out of which 35856(63.99%) were vaginal deliveries. Total number of caesarean sections conducted during this period were 20170(36.0% of the total deliveries). Out of these total caesarean sections: 3875(6.9%) were elective and 16295(29.0%) were emergency caesarean sections. Maternal age ranged between 20 to 43 years with average age 25 years. Antenatal care was received by 5345(9.54%) patients and care givers included lady health visitors, general physicians, private practitioners and government hospitals. Educational status of mother ranged between uneducated to graduates. Indication for caesarean section was fetal distress in 14.2%, failure of progress 5.7%, preterm prelabour rupture of membranes in 10% Hypertensive disorders/preclampsia 4.2%, other medical disorder 1%. The patients included: primigravida 40%, multigravida 60% withrepe at caesarean section in 60%. Breech presentation as indication of caesarean section included12.85% of the total. The maternal ICU admission was required in 1510patients (7.48%). 1207(5.90%) women required blood transfusion antenatal or due to postpartum hemorrhage. Conclusion: Overall Caesarean section rate is 36% (with annual rate of 40-47%) in this study which is high compared to WHO standards of 5%, 10%-15%. According to WHO. There is no empirical evidence for an optimum percentage. What matters most is that all women who need caesarean section receive them.