Rising caesarean section rate; making sense of it is it unavoidable?

ABSTRACT

Compare indications for caesarean section in Military Hospital Rawalpindi in the year 1999 with the year 2005, six years apart, with an aim to identify areas where caesarean section rates could be decreased. Prospective Survey of caesarean section using information provided by doctors/midwives entering data in labour ward /theater registers. The study was designed as a process evaluation. Indication for caesarean section, parity, previous caesarean section, emergency / elective, labour / pre labour, presence of previous caesarean section scar, induced or spontaneous labour were noted. Data was plotted into 2 separate classifications and indications compared across the 2 years 1999 versus 2005. Statistical significance was calculated and value of <0.05 was considered significant. Overall section rates rose from 16.9% to 34.6% which showed almost doubling of rates in a span of 6 years. The chief contributors to rising rates were as follows. Caesarean section rate rose from 132 [2.2%] to 355 [4.6%] for previous one Caesarean section [p<0.001], from 172 [2.9%] to 383 [5%] for previous >1 caesarean [p<0.001], that for nullipara increased from 203 [3.3%] to 632 [8.3%], prelabour or induced labour [p<0.001] and for dystocia from 150 [2.5%] to 490 [6.4%] which was again significant [p<0.001]. Increase in section rate for antepartum haemorrhage, diabetes, previous infertility and intrauterine growth restriction was insignificant. A decrease in the number of caesarean sections may be achieved by reducing the number of primary caesarean section and/or encouraging more patients to take a trial of scar. A decrease in induction rates may also lead to lowering of caesarean section rates