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.

Analysis of success of vaginal birth after cesarean in relation to indication of primary caesarean section: a tertiary care experience

Background: Apprehensions related to vaginal birth after caesarean (VBAC) has reduced rates of successful vaginal trials over last decade. The objective of this study was to identify the indications of first caesarean section that can lead to a successful trial of labour in subsequent pregnancy.Methods: Retrospective cohort study was done between November 2014 and October 2017. Data from the case records was analysed.Results: Study over 3 years from 2014 to 2017 revealed fetal distress (82.7%),  breech (72.2%), transverse lie (66.7%), antepartum haemorrhage (56.2%) and twins with first non-cephalic (57.9%) have successful outcome of VBAC whereas obstructed labour (19.2%) and failed induction (18.4%) in previous pregnancy have poor outcome for VBAC.Conclusions: Attempts to allow trial of labour after one previous caesarean section with fetal distress, malpresentation and twins as indications of caesarean in previous pregnancy are safe and should be encouraged.

Fatores associados à via de parto atual em mulheres com cesariana prévia / Factors associated with mode of delivery in present pregnancy in women with previous caesarean section

O aumento alarmante e crescente das taxas de cesariana é realidade mundial, representando problema de saúde pública, por se associar a maior morbidade materna e fetal além de elevados custos hospitalares. Uma das principais estratégias para diminuir esses índices é submeter a paciente com uma cesariana anterior à prova de trabalho de parto. O objetivo deste estudo foi descrever o desfecho neonatal e via de parto de pacientes com história de cesariana em gestação anterior e compará-los a primíparas. Foram avaliadas 188 mulheres, 94 em cada grupo, no período de janeiro a abril de 2010. A taxa global de cesariana foi de 42%. Nas primíparas 38,2%, e nas pacientes com uma cesariana anterior 77,6%. Apenas 46,8% das pacientes com uma cesariana anterior foram submetidas à prova de trabalho de parto, neste grupo a frequência de parto normal foi de 44,19%. Não houve diferença no desfecho neonatal ou obstétrico entre os grupos. Conclusão: Uma cesariana anterior aumenta em 5,6 vezes a chance de uma nova cesariana na gestação atual se comparadas à primíparas.

The alarming increase and rising rates of caesarean section is a worldwide reality, representing a public health problem, associated with increased maternal and fetal morbidity and higher hospital costs. A strategy to reduce these rates is to submit a patient with a previous cesarean to a trial of labour (VBAC). The objective of this study was to describe neonatal outcome and mode of delivery in patients with a cesarean section in previous pregnancy compared with primiparous. We evaluated 188 women, 94 in each group during the period from January to April 2010. The epidemiological profile of patients who had vaginal delivery or cesarean section were similar. The overall rate of cesarean section was 42%. In primiparous 38.2% and 77,6 % in patients with a previous cesarean section. Only 46.8% of patients with a previous cesarean section were submitted a trial of labor after c-section, in this group the frequency of vaginal delivery was 44.19%. There was no difference in neonatal outcome between groups. Conclusion: a previous caesarean section increases by 5.6 times the chance of a new caesarean section in the current pregnancy compared to primiparous women.

Factors Predicting Success of Trial of Labour among Women with Previous one Caesarean Delivery in a Developing Country.

The objective of the study was to find out the factors predicting outcome of trial of labour after previous caesarean delivery among women living in a developing country. A retrospective study of 149 cases of trial of Labour was conducted in women with a history of one prior caesarean section. Binary logistic regression was used to identify predictive factors. The adjusted odds ratios with 95% confidence intervals (95%CI) were used to indicate risk of failure of the trial of Labour when the factor was present. It was found that success rate of vaginal birth was 24.16%. Factors significantly predictive of success of trial of Labour were previous vaginal delivery (OR 18.4, 3.3 -329.6), baby weight < 3 kg (OR 33.3, 5.4-62.6) and 2nd stage of labour during previous LSCS (OR 2.1, 1-4.2). The study has shown that trial of labour can be attempted successfully, in women with previous caesarean delivery, with due consideration of maternal and foetal outcome. A prior history of vaginal delivery and baby weight < 3 kgs are the best predictor of success of trial of labour.

Maternal and Neonatal Outcome in Patients with History of Previous One Cesarean Section.

Background : Cesarean section has become the most common operation in obstetric practice. A critical evaluation of the attitude towards the liberalization of the indications for cesarean section is warranted. The present study was conducted to determine the maternal and neonatal outcome of pregnancy among women with one previous cesarean section in relation to vaginal delivery, repeat cesarean section, maternal complications and neonatal complications. Aims and Objectives : To determine the maternal and neonatal outcome of pregnancy with previous one cesarean section. To estimate the rate of repeat cesarean section and vaginal deliveries in our population. Research Question : What is the maternal and neonatal outcome in women with history of previous one cesarean section? Study Design : Prospective Study. Study Participants : All women with term pregnancy, with previous one lower segment cesarean section and single live fetus in cephalic presentation. Statistical Analysis : Simple percent and proportions, Chi Square test.