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Background: Caesarean section (C-section) is one of the most widely performed surgical procedure in obstetrics worldwide. The WHO guidelines revised in 1994 states that the proportion of C-section birth should range between 5-15% but both in developed and developing countries C-section rate is on the rise. This study was conducted to analyse the frequency and indications for C-section and associated maternal morbidity and mortality.Methods: This retrospective study was conducted over a period from January 2018 to May 2019 at the department of obstetrics and gynecology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Hingna, Nagpur, Maharashtra, India. Data of patients who delivered by C-section in our hospital during the defined study period were studied and statistically analysed according to various parameters namely, the frequency of caesarean section, its indications, age, parity and gestational age of the patient.Results: The total number of women delivered over the study period were 2811. Out of which C-sections were done in 1461 women (51.97%). Previous C-section was the leading indication in 35.72% women followed by fetal distress 14.09%, failure of induction 12.93%, arrest of labour 7.93%, PIH 7.18%, oligo/IUGR 6.50%, breech 4.44%, refusal of vaginal birth 4.24%, CPD 1.71%, bad obstetrics history (BOH) 1.43%, malpresentation 1.30%, prematurity 1.23%, and multifetal gestation in 1.09% women. Two women had classical C-section 0.07. 14.09% women had various complications. There was no maternal mortality.Conclusions: A high rate of caesarean deliveries was observed. Individualization of the indication and careful evaluation, following standardized guidelines can help us to limit C-section. Audit and feedback are the best way to judge clinical practice and to reduce the frequency of caesarean section in any tertiary setup.
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Background: For asphyxia, the fetus reacts with a series of responses. First there is redistribution of blood flow to vital centres to limit the deleterious effects of oxygen limitation in the brain, heart and adrenal glands. A further compensatory response is that overall fetal oxygen consumption declines to values as low as 50% of the control.Methods: This was a prospective study. Early perinatal outcome of newborns delivered through Caesarean section due to clinical foetal distress in labour was compared with a group of newborns similarly delivered via Caesarean section without a diagnosis of clinical foetal distress. Data collected and analysed using appropriate standard statistical methods i.e. Chi-square (X2) test and ‘Z’ - test.Results: Most common indication for NICU admission in study group was MAS (Meconium Aspiration Syndrome 14%) followed by MAS with perinatal asphyxia (5.33%), MAS with Hypoxic ischaemic encephalopathy (HIE) - stage III (3.33%) paerintal asphyxia (2.66%), severe PNA with HIE - III (0.66%) and TTN (0.66%) meconium gastritis (0.66%) respectively.Conclusions: Clinical foetal distress (study group) was found to be significantly associated with low 1 min and 5 min. Apgar score. There was no significant difference in immediate NICU admission whether D-D (i.e. detection fetal detection to delivery interval) time interval <30 minutes or >30 minutes. But rate of mortality was high when D-D (i.e. detection fetal detection to delivery interval) was >30 minutes.
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Aim& Objectives: To compare the total dose of Fentanyl and Bupivacaine with total dose of Ropivacaine and fentanyl in terms of total volume delivered-loading, infusion and top ups. Also, to compare Analgesic efficacy (VAS score) and adverse events if any. Methods: 60 ASA physical status I or II parturients in labour who were either primigravidae or gravida 2 were included in a randomized, single blind, prospective study. After a bolus dose of 0.125 % Bupivacaine and 25 mcg Fentanyl, the group BF received a continuous epidural infusion of 0.0625% Bupivacaine and 0.0002% Fentanyl whereas the group RF received a bolus of 0.2% Ropivacaine and 25 mcg Fentanyl followed by an infusion of 0.1% Ropivacaine and 0.0002% Fentanyl. Results: The Group BF and Group RF were comparable with respect to their physical parameters. It was seen that the pain relief in the group BF was excellent for 8 out of 30 patients (26.67%) whereas for the group RF it was excellent for 9 of 30 patients (30%). After that till delivery, both the groups had a comparable mean maternal pulse rate (p value >0.05). None of the parturient in study or control group ever had an episode of bradycardia. Throughout the remaining period of analgesia, the mean foetal heart rate was comparable between the two groups. In the present study groups only 2 parturients from group BF and only one parturient from group RF underwent caesarean section due to foetal distress. 6 parturients (20%) from group BF and 5 parturients (16.67%) from group RF developed hypotension. Conclusion: Continuous infusion of 0.1% Ropivacaine + 0.0002 % Fentanyl provides equipotent labour analgesia and maternal satisfaction as 0.0625% Bupivacaine + 0.0002% Fentanyl infusion can provide.
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Background: The risks of maternal morbidity and mortality associated with a caesarean section may not be reasonably justified by the degree of neonatal compromise at birth associated with caesarean section done for clinically diagnosed foetal distress. The aim was to study the association of clinical diagnosis of non-reassuring foetal status with umbilical artery acidaemia at birth in women undergoing caesarean section for foetal distress and to evaluate outcomes in neonates born by caesarean section performed for foetal distress.Methods: Prospective observational study of all the women undergoing emergency caesarean section for foetal distress at a tertiary care teaching facility over 2 months. Criteria for diagnosis of foetal distress were thick meconium stained liquor only or foetal heart rate abnormality with or without meconium stained liquor. Testing for pH was done on arterial blood drawn from umbilical cord at the time of birth. Acidaemia was defined as cord blood pH less than 7.2. Severe acidaemia was defined as cord blood pH less than 7.0.Results: Cord blood pH was analysed in 110 caesareans done for foetal distress. Incidence of neonatal acidaemia at birth in study population was 53.6%.Conclusions: Much lower incidence of actual acidaemia and low Apgar scores in neonates born by caesarean section done for clinical diagnosis of foetal distress than previously reported indicate the need for more stringent criteria and more objective tests for diagnosis of foetal distress.
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Background: In the 21st century caesarean section is the most common operation in modern obstetrics but its indications have been changed in elective and emergency cases. The aim of the present study was to find out the incidence, indication of caesarean, foeto-maternal outcome in patients who came in emergency from rural areas.Methods: This retrospective study was conducted at Pannadhai Mahila Hospital, R. N. T. Medical College, Udaipur from September 2017 to February 2018. All the women who were unbooked, belonged to rural Mewar region and underwent emergency caesarean section.Results: Total no. of deliveries conducted were 1560 in the emergency labour room out of which 462 were emergency caesarean sections. The mean age of the participants was 27 years. Foetal distress was the most common indication (17.75%) followed by prolonged labour/ failed induction 14.5%. Post-partum haemorrhage and adhesions were the commonly encountered complications.Conclusions: LSCS due to maternal and foetal indications is inevitable. Timely performed LSCS decreases the morbidity and mortality. The government of India has also taken initiative in making caesarean deliveries more acceptable, affordable to patients belonging to rural areas. The government is also enhancing primary and community health centers.
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Background: The incidence of Caesarean Section (CS)is increasing day by day among urban and ruralpopulation globally. Hence, a need of the study wasrequired to find out the incidence of CS amongpopulation in a backward district of Karnataka. Aimand Objectives: To evaluate the rising trends in CS ratein both primigravida and multigravida. Material andMethods: This cross-sectional study was carried outamong 513 patients (92.7% rural and 7.3% urban)admitted in labour ward at a tertiary referral centre,Vijayapura, Karnataka. The indications were analysedby standard procedures and the decision for CS wereunder taken by qualified professionals accordingly.Results: Total incidence of CS in the present study was200(38.98%) out of 513 patients admitted. Out of 200patients who underwent CS, were found to beprimigravida 83 (41.5%) and were multigravida 117(58.5%). The most common indication of CS in thisstudy was found to be the Foetal Distress (FD) (35.5%)followed by Cephalo-pelvic Disproportion (CPD)(21%) and others (43.5%). Study also shows 90% ofrural patients (n=180) and 10% of urban patients (n=20)had underwent CS (n=200). Interestingly it was noticedthat age group of 21-30 years had maximum number ofCS (74%). Conclusion: The results indicate the highincidence of CS among rural population of Vijayapura,Karnataka of which the common indication was FD,dystocia and failure to progress of labour. The increasedincidence of CS is in primigravida and primary CS inmultigravida in the perspective of various societal andmedico-legal issues.
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Background: There seems to be gradual raising trend in cesarean deliveries over decades with associated decrease in perinatal mortality rate. This study was undertaken to compare the caesarean delivery (CS) rates along with its indications over the last decade and to examine whether it is changing.Methods: The aim is to compare the rate and indications of CS in a retrospective manner from the data collected between January 1 and December 31 in the year 2006, 2011, and 2016 in a zonal hospital. The rates and indications of CS were analyzed to find whether they are changing if yes which are the factors contributing for the same. Categorical variables were compared using chi-square test.Results: The CS rate showed an increasing trend from 26 % in 2006 to 27.6 % in 2011 to 32.4 % in 2016. Of the total CS, repeat CS rate was significantly increased from 76 (6.61%) in 2006 to 106 (10.34%) in 2011 to 128 (13.72%). Primary CS percent remained more or less same during the study period. Post cesarean pregnancy (p=0.00001) and fetal distress (p=0.012) showed significant rise as an indication for CS which were major contributor for rise in last decade while failed induction decreased.Conclusions: Over the decade there is increase in the total CS rate mainly attributable to repeat CS while post CS pregnancies and foetal distress were leading cause for CS. There is need for reducing primary CS along with increase in trial of labor after cesarean in properly selected women.
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Background: Adequate Amniotic fluid volume is essential for the normal growth and well-being of the foetus. Diminished liquor or oligohydramnios is quite often associated with abnormal foetal outcomes such as intrauterine growth restriction, foetal anomaly malpresentation, post maturity syndrome and foetal distress in labour Methods: The present study was conducted in the Department of Obstetrics and Gynecology, PMCH, Udaipur during the period of March 2015 to February 2016. The study group comprised of 50 clinically and sonographically proven cases of oligohydramnios in third trimester attending antenatal clinic and those admitted in antenatal ward and clean labour room at random. Results: Maximum no. (72% of patients) were in age group of 20-25 years and only 2 patients were less than 20years of age. 68% cases were from urban and 32% were from rural areas, as urban population is more aware about prenatal care. higher incidence of oligohydramnios cases were belonging to lower and middle class families i.e. 44% and 40% respectively and only 8 patients were from upper socio-economic status. Conclusion: it is suggested that for idiopathic oligohydramnios, intravenous aminoacid may prove useful in reducing maternal morbidity and perinatal morbidity and mortality and improving pregnancy outcome in developing countries.
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The purpose of this study was to evaluate the anaesthetic technique for Caesarean section which was appropriate for the clinical situation. This retrospective study was conducted on 240 patients undergoing Caesarean section with indications of foetal distress during a 3-year period (2002-2004). The data were reviewed from the patient’s medical record of the Department of Anesthesiology, Dr Soetomo Hospital, Surabaya. The patients were divided into three groups, according to the criteria of foetal heart rates. The success of the anaesthesia methods was determined by assessing the Apgar scores of the newborn baby. The results were analyse using Kruskal-Wallis and Chi-Square test. P 0.05 was considered as statistically significant. 1- and 5-minute Apgar score of the normal range group was significantly higher than that of the bradycardia group (p0.05). One and five- minute Apgar scores of the subarachnoid block group were significantly higher than those of the general anesthesia group (p0.05). We conclude that subarachnoid block is the choice of anaesthesia for patients undergoing Caesarean section for foetal distress’s diagnosed at PS 1 and 2 patients. General anaesthesia with ketamine Apgar score at one minute better than that of the thiopental.