A Study of the indications of caesarean section in a tertiary care hospital at West Bengal: An observational study

Abstract

Background: In recent decades, we have observed a remarkable increase in the rate of caesarean section (CS) in both developed and developing countries, especially in India.  Its prevalence has increased alarmingly in the last few years, which has motivated this research to identify the indications and determinants, influencing cesarean section delivery in the study area and determine the associated correlates for emergency and elective cesarean sections. Materials & Methods: The prospective study was conducted at a tertiary care hospital with all pregnant women undergoing elective and emergency caesarean section. Interval between the time of administration of antibiotic & time of delivery was assessed. Data on the use of antibiotic prophylaxis in caesarean sections was collected using a customized proforma. Other data included were indication for caesarean section, route of administration of antibiotics, type of antibiotics, dosage of antibiotics, time of incision, and duration of operation. All the methods were compared to Hospital protocol and NICE protocol.  Its prevalence has increased alarmingly in the last few years, which has motivated this research to identify the indications and determinants, influencing cesarean section delivery in the study area and determine the associated correlates for emergency and elective cesarean sections. Results were expressed as proportions, percentages & as averages +/- standard deviation (SD) with corresponding ranges. Results: The mean age (mean ± s.d.) of the patients was 28.94±3.88 years with range 19 - 42 years and the median age was 29 years. Test of proportion showed that proportion of single gravidity 216(70.8%) was significantly higher than that of multi-gravidity 89(29.2%) (Z=8.74;p=0.000001).  Most of the caesarean section 26(8.5%) were underwent as per maternal wish (Z=1.21;p=0.47). Most of the patients 280(91.8%) had intact membrane as compared to ruptured membrane 25(8.2%) (Z=10.19;p=0.000001). The mean duration of surgery (mean± s.d.) of the patients was 75.13±16.96 minutes with range 35-148 minutes and the median was 75 minutes. Most of the surgeries 250 (82%) were performed between 60-89 minutes which was significantly higher (Z=8.04;p=0.00001). Conclusion: Caesarean sections are effective in saving maternal and infant lives, but only when they are required for medically indicated reasons. Unnecessary cesarean section may have an adverse impact upon maternal, neonatal, and infant morbidity and mortality. The high cost of cesarean section may result in catastrophic health expenditure for families and additional pressure upon health systems, especially in low- and middle-income countries.