A Dilemma for Modern Obstetrics -Rising Incidence of Caesarean Section Rate

Objectives: To study the rate of caesarean sections (indications, ratio in emergency and elective caesarean sections) the percentage of vaginal birth after caesarean sections and instrumental deliveries.

Methods: This retrospective study was conducted over a period of one year from 1st January 2018 to 31st December 2018 at the Department of obstetrics and gynaecology, unit 2, Lahore general hospital, Lahore. The data of obstetrical patients who got admitted in the unit and were delivered either vaginally or through abdominal route during the defined study period was recorded and a statistical analysis of various parameters namely the caesarean section rates, its indications, the ratio of emergency and elective caesarean sections, the rate of vaginal births after caesarean section (VBACS) and instrumental deliveries was done.

Results: The total numbers of obstetrical patients admitted over the study period were 18183. Out of which total deliveries were 6602, vaginal births were 3699 and caesarean sections were 2765. The overall caesarean section rate was 41.88%, elective sections were 473(17.1%) and emergency sections were 2292(82.89%). The vaginal births were 3699(56.02%), VBACS were 98(2.6%), instrumental deliveries like forcep deliveries were 31(0.8%) and ventouse deliveries were 47(1.2%). There were 38(1.02%) twin deliveries and 59(1.5%) assisted breech deliveries. The caesarean sections done electively as well as in emergency with different indications were calculated individually.

Conclusions: The rising incidence of caesarean section is most pressing fact of the decade in modern obstetrics. The detailed audit of the caesarean sections done over a year in a tertiary care hospital showed a large number of sections done due to fetal distress. The confirmation of its diagnosis to prevent unnecessary surgeries is pivotal. The previous scars and indications related to them are the most important component in the study so concluding this study to take steps in prevention of primary caesarean section is foremost. Audit and surveillance of caesarean sections should be carried out annually to identify the preventable causes of caesarean sections.