ANALYSIS OF CESAREAN SECTION RATES, INDICATIONS AND COMPLICATIONS IN PREVIOUS CESAREAN SECTION AT TERTIARY CARE TEACHING HOSPITALS IN INDIA (AN ICMR TASK FORCE STUDY)
Balwan Singh Dhillon*, Nomita Chandhiok, Saurabh Sharma and M. Vishnu Vardhana Rao
ABSTRACT
Background: Cesarean section is one of the most common surgeries that is widely performed in modern obstetrics worldwide. It was mainly evolved as a lifesaving procedure for mother and fetus. The objective of this study was to determine the rate, indications and complications of previous cesarean section. Methods: Prospective data was recorded on management practices, associated complications, morbidity and mortality for a period of 8 months in 2005-2006 on 15664 consecutive cases of previous cesarean section reporting at 30 medical colleges/teaching hospitals. Results: A total of 155863 deliveries occurred during the study duration. There were 28.1% (n=43824) cesarean section, out of which 35.7% (n=15664) were the number of previous cesarean section. 41.9% of cesarean cases had come from rural areas, 88.8% were the booked cases and 17% were referred. The leading cesarean indications were cephalopelvic disproportion (39.1%), previous 2 cesarean section (15.8%), foetal distress (11.5%), doubtful scar integrity (6.9%), malpresentation (5.5%), non-progress of labor (5.3%), severe pregnancy induced hypertension/eclampsia (5.2%). Anesthesia complications (0.9%), surgical complications (3.6%), post-operative complication (5.9%) and blood transfusion (7.4%) were required. There were 27 (0.17%) maternal deaths and 253 (1.6%) perinatal deaths. Conclusions: A high rate of cesarean section was observed in the tertiary care hospitals. There is a need to conduct hospital and community based studies to monitor the cesarean section rates and further evaluate the common indications for cesarean section in India. Individualization of the indication and careful evaluation, following standardized guidelines, practice of evidence-based obstetrics can help to limit cesarean section rate.
Keywords: Cesarean Section, Rate, Indications, Complications, India.
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