audit of cesarean sections in a teaching hospital

ABSTRACT

To determine the frequency of factors responsible for apparently high cesarean section rate in teaching hospital, Liaquat university hospital Hyderabad and to assess maternal morbidity and fetal out come after cesarean section. Descriptive study. In obstetric and gynecology Department of Liaquat university hospital Hyderabad Sindh Pakistan from 3 rd January 2007 to 2 nd January 2008. Total 1666 deliveries were conducted in year 2007 to 2008. Out of these 584 were delivered by cesarean section and 1082 were delivered by normal vaginal delivery. Clinical record of all the patients who underwent Cesarean section was analyzed. All the patients who underwent cesarean section were included in this study while clinically diagnosed cases of ruptured uterus and proved on lapratomy were excluded from this study. A proforma of each patient was completed, regarding the relevant information of cesarean delivery and fetal outcome. Cesarean section was done on 584 [35%] patients while normal vaginal delivery was conducted on 1082 [65%] patients. A total of 149 [25.5%] patients' underwent elective cesarean section while in 435 [74.4%] patient's cesarean section was done in emergency. A total of 144 [24.7%] patients were booked while 440 [75.3%] patient's were unbooked. Most common indication of cesarean section was repeat cesarean section, which was seen in 182 [31.2%] patients. Among obstetric complications major problem encountered was massive hemorrhage, which is seen in 64 [11%] patients wounds sepsis was second most common complications. A total of 453 [77.6%] newborns were born alive and 50 [8.6%] neonates were dead which included fresh and macerated still birth. 81 [13.8%] neonates died later on in pediatric unit [END]. The rate of cesarean section in our study was 35%, which is quite high. Commonest indication of cesarean section observed in this study was previous cesarean section. Majority of patient's who underwent cesarean section were unbooked. Commonest obstetric complication was massive hemorrhage followed by wound sepsis. Perinatal mortality was also high in this study