Are we operating unnecessarily?: caesarean audit in a single unit of a private tertiary care hospital in North India

ABSTRACT

Background: Caesarean section emerged as a lifesaving surgery in situations where vaginal delivery could put the mother and fetus at risk. Over the years global rise in caesarean delivery rate has been alarming and may be attributed to changes in medical practice and societal expectations, especially in urban areas and developing countries. Rising caesarean rate is worrisome as it increases maternal morbidity, exposes the mother to future obstetric risks, besides increasing financial burden on the health care system. Caesarean audits could be an effective tool to analyse, understand and propose solutions to reduce caesarean rates. Hence, this retrospective study was conducted to audit caesarean sections done over a period of 5 years (2011 to 2015) in a single unit of a tertiary care private hospital in North India.Methods: The case records of all caesarean deliveries from January 2011 to December 2015 were analysed retrospectively for demographic profile, clinical parameters and recorded indication of caesarean section on the basis of Robson’s classification.Results: The caesarean section rate in the study was 61.8%. According to Robson’s 10 system classification, Group 2, 5 and 10 were the largest contributors. The commonest indication was previous LSCS (18.7%) followed closely by fetal distress (15.4%) and prolonged labor/failed induction (13.3%). Maternal request contributed 10.6% of the Caesarean deliveries.Conclusions: The caesarean section rate in our study is way higher than the national average. We need to re-duce caesareans in primigravidae and consider VBAC where appropriate. Use of Electronic fetal monitoring during labor needs to be optimized. Appropriate use of oxytocics, proper monitoring and using robust criterion to infer non progress of labor are important. Appropriate counselling and assured pain management during labor may help reduce caesareans on maternal request.