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

2020 ◽  
Vol 9 (3) ◽  
pp. 975
Author(s):  
Nidhi Singh ◽  
Manjusha .
Keyword(s):  
Caesarean Section ◽  
Urban Areas ◽  
Single Unit ◽  
Financial Burden ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
North India ◽  
Care Hospital ◽  
Appropriate Use ◽  
Maternal Request

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.

Study on Maternal and Neonatal Outcome of women undergoing Caesarean Section using Nice Classification in a Tertiary Care Hospital in Rural Area of Central India - An Observational Prospective Study

2021 ◽  
Vol 17 ◽  
Author(s):  
Shuchi M. Jain ◽  
Ketki. Thool ◽  
Manish A. Jain ◽  
Poonam V. Shivkumar
Keyword(s):  
Caesarean Section ◽  
Prospective Study ◽  
Neonatal Outcome ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Central India ◽  
Neonatal Morbidity ◽  
Bladder Injury ◽  
Care Hospital ◽  
Chi Square

Background : Caesarean section is often perceived to be safer than vaginal delivery for mothers and neonates, and thus has become increasingly common around the globe. However, it may actually be detrimental to maternal and neonatal health while consuming valuable resources. Objective : The objective of this study was to categorize the caesarean sections performed in our rural institute into various categories using NICE classification and to study the maternal and neonatal outcome in them. Method : This was a prospective study of all women who underwent caesarean section over a period of 18 months. Data was retrieved from the files of women for morbiditiy and mortality in mothers and babies. Data was entered in MS excel sheet and analyzed with percentages and chi square test using SPSS ver.17. Results: Caesarean section rate (CSR) was 36.88%. All CS were classified into four categories based on urgency as per NICE guidelines. There were 22.62% women in Category I, 38.61% in category II, 28.37% in category III and 10.40% in Category IV. Adhesions, extension of angle, lacerations in lower segment, scar dehiscence, atonic PPH and bladder injury were noted in (12.83%), 11.81%, 6.83%, 4.08% , 1.53% and 0.08% CS respectively. Caesarean hysterectomy was done in 0.24% cases. Postoperative morbidity was febrile morbidity (11.93%), postdural puncture headache (13.85%), paralytic ileus (11.49%), wound infection (8.83%), ARDS (0.70%), sepsis (0.78%), pulmonary edema (0.47%) and pulmonary embolism (0.03%). Maternal mortality was 0.03%. Neonates born were 2577 (29 were twin deliveries). 82.46% neonates were healthy, 16.80% had morbidities and 0.74% were still born. Apgar score of less than 7 was in 10%. 16.80% neonates were admitted in NICU during their hospital stay. Neonatal mortality was 1.47%. Conclusion : Intraoperative and post-operative complication were more in caesarean sections of category I and II as compared to category III and category IV. Neonatal morbidity, mortality and admissions to NICU were more in caesarean sections of category I and II as compared to category III and category IV. Thus though caesarean section is an emergency lifesaving procedure for mother and baby it may prove detrimental to their health.

scholarly journals Analysis of caesarean section rate in tertiary care hospital according to Robson`s 10 groups classification

2018 ◽  
Vol 7 (4) ◽  
pp. 1380
Author(s):  
Varija T. ◽  
Veerendra Kumar C. M. ◽  
Chandrasekhar Tarihalli
Keyword(s):  
Caesarean Section ◽  
Classification System ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Case Series ◽  
Breech Presentation ◽  
Group Classification ◽  
Care Hospital ◽  
Case Series Study ◽  
Group 5

Background: The caesarean section (CS) delivery rate is steadily increasing worldwide, including India. Identifying the proportion of women in various categories as per Robson's ten group classification system and CS rate among them is important to bring down the increasing CS rate.Methods: This case series study was conducted at Vijayanagar Institute of Medical Sciences (VIMS), a tertiary care teaching hospital in Ballari, Karnataka, India. All pregnant women who have been admitted for delivery were enrolled and the data was collected for the women delivered by CS during January 2016 to December 2016 and proportions in various groups as per Robson’s ten-group classification system were calculated.Results: Among a total of 6980 women delivered during study period, 2992 (42.8%) delivered by CS. The CS rates among various groups varied from 100% among women with abnormal lies and group 6-95% (all nulliparous breeches) group 5-94% (Previous CS, single cephalic, >37 weeks) to 10 to 15% among multiparous women with spontaneous labour having single cephalic pregnancy (group 3). Among women with previous section, CS rate was very high (89.6%). Women with previous CS (group 5) contributed maximum (40.24%) to the total number of CS.Conclusions: In the present study, all women with breech presentation and abnormal lies delivered by CS and repeat CS was the highest contributor to all CS deliveries.

scholarly journals The ten group Robson classification: a retrospective study to identify strategies to optimise caesarean section rates

2020 ◽  
Vol 9 (12) ◽  
pp. 5082
Author(s):  
Spandana S. ◽  
Amarpali K. Shivanna
Keyword(s):  
Retrospective Study ◽  
Caesarean Section ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Group Classification ◽  
Care Hospital ◽  
Robson Classification ◽  
Vaginal Deliveries ◽  
Group 5 ◽  
Ongoing Surveillance

Background: Caesarean section rates have been increasing worldwide. For proper assessment, the ten group Robson classification is recommended by WHO for assessing CS rates. We are analyzing the caesarean section rates by classifying the caesarean sections using modified Robson’s ten group classification. Objective of the current study was to estimate caesarean section rates in our hospital and to classify caesarean section using modified Robson’s ten group classification system.Methods: Current retrospective study was conducted in the department of obstetrics and gynaecology in a tertiary care hospital. The medical records were reviewed for a period of 12 months.Results: Total number of deliveries during the study period was 315. The total numbers of caesarean section were 159 and total vaginal deliveries were 156. The caesarean section rate was 50.47%. The main contributors to overall caesarean section rate were group 5 (18.10%), group 2 (13.96%) and group 1 (5.71%). Women with one previous LSCS contributed majorly to the caesarean section rate. Higher CS rate was also seen in both group 2A (69.40%) and group 4A (47.30%) which had underwent induction of labour. More inclination towards trial of labour following CS for women with previous one LSCS can lower CS rates.Conclusions: Modified Robson’s classification is easily implementable and an effective tool for ongoing surveillance. The results can be compared between Institutions, states and countries. Having implemented the Robson classification and identified groups which contributed the most to the overall CS rate, interventions to reduce the same has to be our prime objective.

scholarly journals Seroprevalence of syphilis among pregnant females attending antenatal clinic at a tertiary care hospital in North India

2020 ◽  
Vol 8 (2) ◽  
pp. 539
Author(s):  
Noor Jahan ◽  
Swastika Singh Chandel ◽  
Deepak Chopra ◽  
Arshiya Khan ◽  
Razia Khatoon
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Tertiary Care ◽  
Transmitted Disease ◽  
First Trimester ◽  
Antenatal Clinic ◽  
North India ◽  
Care Hospital ◽  
Cross Sectional ◽  
Pregnant Females

Background: Syphilis is a sexually transmitted disease caused by bacteria named Treponema palladium, subsp. pallidum. Nearly 1.36 million pregnant women are known to be affected by syphilis in the developing countries. When left untreated syphilis during pregnancy can result in adverse fetal outcomes such as spontaneous abortion and stillbirth. Objective of the study was present study was done to evaluate the seroprevalence of syphilis among pregnant females attending Antenatal Clinic (ANC).Methods: A hospital based cross-sectional study was done over a period of six months from January to June 2019. A total of 132 pregnant females were included in the study who attended Antenatal Clinic for routine checkup whose blood samples were sent to Microbiology Laboratory for screening for syphilis by Rapid Plasma Reagin (RPR) test.Results: Out of 132 samples of pregnant females screened for syphilis, none of the sample was found reactive for syphilis by RPR test. Maximum patients (57.6%) belonged to age group 20-25 years followed by (27.3%) of 26-30 years. 30.3% patients belonged to urban areas and 69.7% patients belonged to rural areas. Majority of patients (80.3%) belonged to first trimester, followed by (18.9%) patients to second trimester and (0.8%) patients to third trimester. 78.8% patients were from lower socio-economic class followed by 12.9% patients from middle class and 8.3% patients from upper class.Conclusions: Although zero percent syphilis prevalence was observed in this study, it is recommended that free screening for syphilis should be offered to all pregnant females visiting Antenatal Clinic.

scholarly journals The rate and indications of caesarean section in a tertiary care hospital at Jaipur, India

2017 ◽  
Vol 6 (5) ◽  
pp. 1786
Author(s):  
Meeta Gupta ◽  
Vineeta Garg
Keyword(s):  
Caesarean Section ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Breech Presentation ◽  
Morbidity And Mortality ◽  
High Rate ◽  
North India ◽  
Care Hospital ◽  
Failed Induction ◽  
Evidenced Based

Background: Caesarean section is one of the most widely performed surgical procedures in obstetrics worldwide. It was mainly evolved as a lifesaving procedure for mother and foetus during the difficult delivery. To analyze the rate and indications for C-Section and associated maternal morbidity and mortality were the main objectives of present study.Methods: This retrospective study was conducted over a period of one year from 1st Jan 2016 to 31st Dec 2016 at the Department of OBG, RUHS College of Medical Sciences, Jaipur (Rajasthan), North India. Data of patients who delivered by C-Section in our hospital during the defined study period was recorded and a statistical analysis of various parameters namely, the caesarean section rates, its indications, the patient’s morbidity and mortality was done.Results: The total numbers of women delivered over the study period were 2959, out of which C-Sections were 931. The overall CS rate was 31.46%. Previous LSCS was the leading indication to the CS rate (36.52%) followed by arrest of labour (13.65%), CPD (12.03%), foetal distress (11.82%), breech presentation (7.52%), oligohydroamnios/IUGR (5.16%) and failed induction of labour (3.54%). 11.60% patients had various complications mainly infection (5.58%) and haemorrhage (3.98%). There was no mortality during this period.Conclusions: Being a tertiary care hospital, a high rate of Caesarean deliveries was observed. Individualization of the indication and careful evaluation, following standardized guidelines, practice of evidenced-based obstetrics and audits in the institution, can help us limit CSR.

scholarly journals Retrospective analysis of indications of primary caesarean sections done at a tertiary care hospital

2019 ◽  
Vol 8 (8) ◽  
pp. 3161
Author(s):  
Kamna Datta ◽  
P. Singh ◽  
Namita Chopra
Keyword(s):  
Caesarean Section ◽  
Tertiary Care Hospital ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Fetal Distress ◽  
Morbidity Rate ◽  
New Delhi ◽  
Care Hospital ◽  
Maternal Risk ◽  
Proper Patient Selection

Background: Caesarean section rates have globally risen above the levels that can be considered medically necessary. The aim of the study is to analyze the rate and indications of caesarean sections for primigravidae in the period 2016 to 2018 at a tertiary care hospital in Delhi.Methods: It is a retrospective observational study conducted in the Department of Obstetrics and Gynaecology at PGIMER and Dr RML Hospital, New Delhi. A total of 552 caesarean deliveries in primigravidae were studied.Results: The total deliveries during the study period were 3346 and the total caesarean section rate observed was 30.66%. The caesarean section rate among primigravidae was 29.1%. The rate of caesarean section in primigravidae rose from 22.7% in 2016 to 39.3% in 2018 with 17% increase. Majority of them belonged to the age group 20-30 years (79.34%) and 2.53% were elderly primigravidae. Out of the total number of primigravidae caesarean deliveries, 67.2% were performed in emergency and 32.7% were performed electively. Among the emergency caesarean sections performed, 64% of patients had induced labor and 22% had spontaneous labor. The most common indication of caesarean section was fetal distress (19.77%) followed by arrest of labor (17.87%) and malpresentations (8.9%). The short-term caesarean morbidity rate was 25.4% including one mortality. Wound infection was the most common complication.Conclusions: Various reasons like changing maternal risk profile increased IVF pregnancies, scientific advances, personal choice and medico legal considerations have been cited for increased caesarean rate. Following evidence-based labor protocols, judicious use of cardiotocography, proper patient selection for labor induction and patient education will contribute in reduction of caesarean sections and related complications.

scholarly journals Caesarean Section Rate and Frequencies of Indications Using Robson–Ten Classifications

2021 ◽  
Vol 8 (4) ◽  
pp. 43-47
Author(s):  
Sadia Ali ◽  
Shazia Khattak ◽  
Rabeea Sadaf ◽  
Shamshad Begum ◽  
Nasreen Kishwar
Keyword(s):  
Retrospective Study ◽  
Caesarean Section ◽  
Cesarean Section ◽  
Tertiary Care Hospital ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Cesarean Section Rate ◽  
Obstetrics And Gynecology ◽  
Care Hospital ◽  
Hospital Records

OBJECTIVES: To determine the caesarean section rate (CSR) and frequency of different indications of caesarean section (CS) in a tertiary care hospital. METHODOLOGY: A retrospective study done in the Department of Obstetrics and Gynecology Hayatabad Medical Complex Hospital Peshawar, a tertiary care hospital, from a period of 1st January 2019 till 31st December 2019. The required data was collected from the patient’s hospital records (clinical charts) with the consent of the hospital ethical committee. RESULTS: The total number of deliveries over the study period was 5611. Out of these 1258 patients were delivered through caesarean section (CS), giving a CSR of 22%. The main contributing groups in our study were Robson Groups R5 (multiparous with prior CS, singleton, cephalic and >37 weeks), R1 (nulliparous, cephalic, singleton >37 weeks in spontaneous labor or CS) and R6 (all nulliparous breeches) with percentages of 21.1%, 17.5% and 12.9% respectively. CONCLUSION: Our study showed Robson Groups 5, 2 and 6 as the major contributors, focusing on these groups could have an impact on decreasing the cesarean section rate in future. Limiting the primary cesarean section rate can affect the overall cesarean section rate (CSR).

scholarly journals A cross-sectional study on factors influencing caesarean section rates in a tertiary care hospital, Jhansi (Uttar Pradesh)

2021 ◽  
Vol 8 (9) ◽  
pp. 4404
Author(s):  
Swati Singh ◽  
Anil Kumar Malhotra
Keyword(s):  
Caesarean Section ◽  
Caesarean Delivery ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Health Care Facilities ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Maternal Risk

Background: Worldwide rise in caesarean delivery (CD) rates during the last three decades has been a cause of alarm. The rates of such delivery have increased dramatically in recent years from 12% in 1990 to 24% in 2008. Tertiary care centers have high caesarean section rates but areas where health care facilities are not available may have maternal deaths due to lack of C-section facilities. The present study was conducted to determine the prevalence of caesarean section, to assess the association between caesarean section with socio-demographic determinants and maternal risk factors.Methods: Cross-sectional study was conducted during January 2016 to April 2016. A total of 288 pregnant females admitted in obstetric ward of medical college Jhansi formed the study population, a simple random sampling technique was adopted for the study. A study tool was pre-designed and pre-tested interview schedule. The data collected was entered in MS excel and analyzed using SPSS 24 version.Results: The study showed that 73 (25.34%) of our study participants have delivered by caesarean section. Caesarean section was significantly associated with literacy, place of residence, education status, socio-economic status and occupation of the husband. Caesarean section was significantly associated with maternal risk factors like obesity, pregnancy induced hypertension, gestational diabetes mellitus and polyhydromnios.Conclusions: Present study found a high caesarean section rate as compared to the WHO standard. Utilization of antenatal care, better doctor patient communication, doctor’s commitment to reduce the rate of LSCS, may help to reduce the increasing rate of caesarean delivery.

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