How safe is caesarean section.

Over an almost 5 year period, 8,017 caesarean sections were done, and there were 51 maternal deaths following caesarean section (of which 5 were done outside). Caesarean section deaths accounted for 1 in 8 overall maternal deaths in the hospital, and institutional mortality for caesarean section was 5.7/1,000 operations. The causes of death included haemorragic shock in 19 (37.3%), general anaesthesia (11.6%), hypertensive disorders 5 (9.8%), general anaesthesia in hypertensive pregnancies 4 (7.8%), septicaemia 7 (13.7%), hepatic failure 3 (5.9%), pulmonary edema 2 (3.9%) and unknown including pulmonary embolism 6 (11.6%). Five deaths followed elective operations. Caesarean section done in cases of antepartum haemorrhage, hypertensive disorders, post caesarean pregnancies with adherent placentae and obstructed labour caused the majority of caesarean mortalities.

Perinatal mortality in caesarean section: a disturbing picture of unfulfilled expectations.

Indications for caesarean section had been studied in a 2-year period and the incidences were compared to that of the same 15 years back. Though there are more incidences of caesarean section, still perinatal death is a major concern to all. The study included a total of 291 perinatal deaths of which there were 208 early neonatal deaths and 83 stillbirths over a period of 2 years from January, 1990 to December, 1991. Caesarean section is being increasingly performed for foetal interest, but this study reveals that perinatal mortality is still high though cesarean section rate has increased in recent times.

PIP: In India, obstetricians compared cesarean section rates at Eden Hospital of the Medical College in Calcutta between 1990-1991 and 1976-1978 to examine cesarean section-associated perinatal mortality. During 1990-1991, there were a total of 291 perinatal deaths (208 early neonatal deaths and 83 fetal deaths) for a perinatal mortality rate of 89.6/1000 total births. Cesarean section rates increased for almost all indications between 1976-1978 and 1990-1991, except repeat cesarean sections antepartum hemorrhage, and malpresentation. Between the 2 periods, perinatal mortality increased despite the increase in cesarean sections. Most stillbirths (67.5%) were a result of antepartum hemorrhage, while most neonatal deaths (53.4%) were a result of nonprogress of labor. Yet, between the 2 periods, the use of cesarean section for nonprogress of labor almost doubled (9.7-17.5%). 25% of early neonatal deaths occurred among elective cesarean section cases. 10 of these infants weighed less than 2 kg. Asphyxia brought on by prematurity was responsible for many perinatal deaths. These findings suggested that the increase in cesarean sections did not improve perinatal deaths.