Original Research Article

Prevalence and indication of caesarean section

in a tribal medical college of south India
Smita Thakkarwad1, Suryakant Mundlod2*
{1Associate Professor, Department of OBGY}{2Associate Professor, Department of Pediatrics} PCMC-PGI-YCMH Pimpri Pune -18,
Maharashtra, INDIA.
Email: smithathakkarwad81@gmail.com , dr_surya@rediffmail.com

Abstract Background: Cesarean section is one of the most widely performed surgical procedures in obstetrics around the world. It
was developed primarily as a life-saving procedure for the mother and fetus during difficult labor. Analyze prevalence
and indications for cesarean section. Methods: this retrospective study was conducted in the OBGY department of Rajiv
Gandhi's Institute of Medical Sciences. Adilabad Medical College, Telangana. Date of patients who gave birth by
cesarean section Result: The results were 8405, of which the caesarean sections were 2899. The overall prevalence of CS
was 34.4%. The previous LSCS was the main indication of the prevalence of CS (31.10%) followed by fetal distress
(28.57%), obstructed delivery (9.60%), CPD (6.14%), breech presentation (5 , 20%), Oligohydramnios / IUGR (8.10%),
failure to induce labor (2.10%), pregnancy-induced hypertension (PIH) (2.87%) and multi-fetal pregnancy (1.24%),
prematurity (3.30% ). 12.01% of patients had various complications, mainly infection (6.27%) and hemorrhage (3.48%).
Conclusions: being a tertiary care hospital, a high prevalence of cesarean section has been observed, it can help us to
limit CSR, following standardized guidelines, evaluations based on obstetrics and audit in the institution.
Key Word: cesarean section (CS), prevalence of cesarean section, CS indications, cesarean section rate (CSR)
*Address for Correspondence:
Dr. Suryakant Mundlod, Associate professor, Department of pediatrics, PCMC-PGI-YCMH Pimpri Pune -18, Maharashtra, INDIA.
Email: dr_surya@rediffmail.com
Received Date: 24/09/2019 Revised Date: 11/10/2019 Accepted Date: 08/11/2019
DOI: https://doi.org/10.26611/10121229

maternal and perinatal morbidity compared to vaginal

Access this article online births even in low-risk cases.3 The rapid increase in the
Quick Response Code: prevalence of caesarean section from 1996 to 2011
Website: without clear evidence of concomitant decreases in
www.medpulse.in maternal or neonatal morbidity or mortality raises a
significant concern of Caesarean section is abused.4
indications of cesarean section vary between institutions
as there is no standard classification system for caesarean
Accessed Date:
section indications. A major challenge is that the
18 November 2019 definitions are not standardized and that the indications
may be multiple or related.5 The most common
indications for cesarean delivery include, in order of
INTRODUCTION frequency, labor dystocia, abnormal fetal heart prevalence
Caesarean section It is one of the most widely performed screening or indeterminate fetal presentation, poor,
surgical procedures in obstetrics worldwide. It was multiple gestation and suspected fetal macrosomia.4 To
developed primarily as a procedure to save the life of the understand how far caesarean sections can be prevented,
mother and fetus during difficult labor1. There is a it is important to know why the caesarean sections were
progressive increase in caesarean sections worldwide; in performed. This study aims to find the prevalence of
developed and developing countries. This increase in cesarean section, various indications on the procedure and
caesarean section Prevalence has become a serious public their relative contribution to total CSR. This is a step to
health problem, because. It is a burden on the health find indications of LSCS that can help us reduce the
system and stress families.2. It has been observed that prevalence of incidence in the institution in the future
cesarean births are associated with an increased risk of

How to cite this article: Smita Thakkarwad, Suryakant Mundlod. Prevalence and indication of caesarean section in a tribal medical college
of south India. MedPulse International Journal of Gynaecology. November 2019; 12(2): 54-56. http://medpulse.in/Gynacology/index.php
 MedPulse – International Journal of Gynaecology, ISSN: 2579-0870, Online ISSN: 2636-4719, Volume 12, Issue 2, November 2019 pp 54-56

AIMS AND OBJECTIVE indications, the previous cesarean section was the most
The aim of this study was to find the prevalence and frequent indication (31.10%). After this fetal distress
different indications of caesarean section. (28.50%), the progress of labor failed (9.69%) and
Inclusion criteria: Age 20-45 years, with Gestational oligohydramnios / IUGR (8.1%) and CPD (6.1%) were
age> 28 weeks patients for caesarean section. the main causes of cesarean section
Exclusion criteria: Gestational age< 28 weeks. Table 1:
No of cases Percentage %
MATERIAL METHOD Elective LSCS 1145 39.5
This retrospective study was conducted for a period of Emergency LSCS 1754 60.5
one year from 1 January 2016 to 31 December 2016 in Table 2:
the OBGY department of the Rajiv Gandhi Institute of the Indications of CS No of cases Percentage %
Faculty of Medical Sciences of Adilabad, Telangana. To Previous LSCS 898 31.1
observe the prevalence of cesarean section and the Fetal Distress 823 28.50
various indications that contribute, the data were obstructed labor 278 9.6
collected retrospectively on all deliveries that took place CPD 177 6.1
between 1 January 2016 and 31 December 2016 at the Breech presentation 151 5.2
Department of Obstetrics and Gynecology. The theater of oligohydroaminous/IUGR 235 8.1
operations of the university has a record in which all the failed induction of labor 61 2.1
data, like the indications, have been recorded together Pregnancy induced hypertension(PIH) 81 2.8
multifetal gestation 35 1.2
with other demographic profiles, such as age, reservation,
Prematurity 154 5.3
address without reservation. Whether the procedure was Total 2889 100
performed as an emergency or was a planned surgery.
Previous obstetric history and current obstetric DISCUSSION
parameters such as prenatal care, gestational age and even Primary cesarean section generally determines the future
the name of the surgeon and anesthesiologist are obstetric course of any woman and, therefore, should be
documented. Complications were also observed during avoided whenever possible. The prevalence of caesarean
surgery and the postoperative period. The various section in our study was 34.40%. The increase in the
categories of indications for cesarean section included prevalence of cesarean section is a worldwide
fetal distress, previous cesarean section, failed induction phenomenon, although the WHO states that there are no
and obstructed delivery, multiple pregnancy, poor further benefits associated with an increase in the
presentation, cephalopalvic disproportion, fetal prevalence of caesarean section above 15% 6. In England,
indications, maternal indications and obstetric indications. the prevalence of cesarean section was 9% in 1980, which
Fetal indications included fetuses with growth retardation increased to 21.3% in 2007.7 The reasons for the increase
(IUGR), prematurity, large child> 3.5 kg and congenital in cesarean section are many, such as the liberal use of
malformations in which vaginal delivery was not cesarean section in high-risk cases such as breech
possible. Maternal indications are maternal conditions presentation, previous cesarean section, fetus with stunted
present before pregnancy that could complicate labor growth, multiple pregnancy, premature baby. Improved
such as VVF repair, previous uterine surgery such as safety of cesarean section with better surgical techniques,
myomectomy, medical causes that could be complicated anesthesia, better availability of blood and its products,
during labor, such as heart disease and old age. Of 8405 advanced antibiotics. Patient fear of labor pain.
patients, 2899 caesarean sections were performed; The Occupational obstetric program, especially those working
data were analyzed to determine the frequency of various in the private sector and also obstetrician's apprehension
causes of cesarean section. The approval of the about the fear of a bad neonatal outcome. Increased
institutional ethics committee has been taken. incidence of IVF and other high-risk pregnancies. The
most common indication in our study was the previous
RESULT cesarean section (31.5%). Lubna Ali of Karachi Pakistan
8405 pregnant women, 2899 women undergoing cesarean reported that the previous cesarean section is the most
section were included in the study. The prevalence of common indication for cesarean section 8, Mersaovdi et
cesarean section was 34.49%. The results showed that out al.9 found similar trends in northern Greece (30.9%). A
of 2899 cesarean sections, 1145 caesarean sections single cicatricial test in pregnancy can be performed to
(39.5%) were performed electively, while 1754 caesarean reduce the prevalence of repeated cesarean section
sections (60.5%) were performed in an emergency form because the risk of uterine rupture is low 0.3% 10.
(table 1). As regards the various caesarean section Successful vaginal delivery after a cesarean section

Copyright © 2019, Medpulse Publishing Corporation, MedPulse International Journal of Gynaecology, Volume 12, Issue 2 November 2019
 Smita Thakkarwad, Suryakant Mundlod

(VBAC) in large multipart patients does not lead to a  Good analgesia and adequate fetal monitoring
greater maternal complication11. The second most during labor
frequent indication observed in our study was 28.5% of  Avoiding undue inductions of labor.
fetal distress. This is mainly due to the referral of a  Trial of VBAC should be encouraged in
patient from the peripheral hospital, since Adilabad is the appropriate cases.
only government of reference. hospital within a radius of  Expertise in external cephalic version and
130 km, so most patients who have come are accustomed vaginal breech delivery in good selected cases.
to suffering from fetal distress. similar observation of  Proper training of traditional birth attendants and
high caesarean prevalence with indication of fetal distress lady health visitors, effective working of referral
as a most common indication in Ratan Kumar Das chain and time demanded health policies.
study.12 Current research suggests that induction of labor
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Source of Support: None Declared
Conflict of Interest: None Declared

MedPulse – International Journal of Gynaecology, ISSN: 2579-0870, Online ISSN: 2636-4719, Volume 12, Issue 2, November 2019 Page 56