A root cause analysis of increasing caesarean section rates in a tertiary care private hospital in North India

Background: Increase in the incidence of caesarean section is a matter of concern worldwide. Robson’s criteria which is universally accepted now as a way for calculating caesarean rates takes into account only the obstetrical consideration, however, it is noteworthy that many socioeconomic and cultural factors also have a role to play. This study takes into account both Robson’s criteria and common socio-cultural factors which lead to increased caesarean rates with an attempt to suggest ways to curtail this trend.Methods: The study was a hospital based cross-sectional study at a private tertiary care hospital in New Delhi. 1200 consecutive live births after 34 weeks of gestation were analysed over a period of one year.Results: LSCS was the most common mode of delivery 733 (61.1%). 329 (27.4%) had induced labour of which 260 (76.2%) had LSCS. 333 women had elective LSCS. Rates of CDMR were 185 (25.2%) which is very significant. As per Robson’s criteria maximum number of women (318) were in group 2, of which 226 (71.1%) underwent caesarean section.Conclusions: High caesarean rates can be attributed to a multitude of factors. Robson’s criteria are an effective way for analysis of obstetric indications. Other added factors include comorbidities, CDMR, fear of litigations, etc which were analysed.

Vaginal Birth After One Previous Lower Segment Caesarean Section Puja Puri, Mary Abraham, Seema Grover.

To find out the incidence and factors favorable for vaginal delivery after previous one lower segment CS and to document maternal and fetal complications if any in these women.It was a three year study (two year retrospective and one year prospective) and a total of 205 women with previous one lower segment CS for non recurrent indication were included in the study. Case selection for trial of vaginal delivery was done as per the ACOG guidelines.Out of 205 women who were given trial of labor, 56.1% had a vaginal birth after Caesarean section (VBAC) and 43.9% required emergency repeat CS. There was no maternal or neonatal mortality and also no case of uterine rupture.A trial of vaginal delivery after previous one LSCS in selected patients can eliminate the need for a large proportion of repeat CS. This can significantly decrease the incidence of postpartum morbidity, anesthetic and operative risks and financial liabilities.