An evaluation of the indications for caesarean sections at Chris Hani Baragwanath Academic Hospital

Abstract

RESEARCH Background.A systematic review concluded that a caesarean section (CS) performed for medical indications will save lives; however, it is associated with short-and long-term complications. The CS rate at Chris Hani Baragwanath Academic Hospital (CHBAH) was 39.78% in 2015. Objectives. To evaluate the indications for CSs at CHBAH. Methods. This was a cross-sectional study conducted on the data collected in the week of 23 June to 29 June 2015. Each file was evaluated for the correctness of the decision by at least two researchers. Each reviewer could state that he/she absolutely agreed, partially agreed, did not agree or could not make an assessment. Results. The mean (standard deviation (SD)) age of the women was 27.01 (6.35) (range 15 -44) years. The median (interquartile range (IQR)) parity was 1 (0 -2) (range 0 -4). No co-morbidities were found in 13.6% (n=20) of the reviewed cases. Complications were found to have occurred in 17% (n=25) of women who gave birth over the week reviewed. The median (IQR) gestational age at delivery was 38.14 (36.39 -40.14) (range 28.0 -42.4) weeks. The median (IQR) Apgar (5 minutes) was 10 (9 -10) (range 0 -10). The median (IQR) birth weight was 3 040 (2 530 -3 440) (range 825 -4 575) g. The most common indications were fetal distress (n=73; 49.66%) and dystocia (n=42; 28.57%). There was absolute agreement between the two reviewers in the following: retained second twin, antepartum haemorrhage (APH) of unknown origin, placenta previa, severe intrauterine growth restriction, multiple pregnancy, abnormal presentation, eclampsia and two previous CSs. When the indication was fetal distress, dystocia, second-stage CS, or one previous CS, the absolute agreement was between 73.85% and 90.24%. Conclusion. There were few absolute disagreements with the indication cited. Methods used to diagnose fetal distress and dystocia must be evaluated. In 2015, the World Health Organization (WHO) statement on caesarean section (CS) rates stated that 'Every effort should be made to provide a caesarean section to women in need, rather than striving to achieve a specific rate' . S Afr J Obstet Gynaecol[1] A CS should be undertaken when it is medically necessary and efforts should focus on providing a CS to all women in need. However, defining a woman 'in need' can only be ascertained by the healthcare providers caring for the woman on a case-by-case basis.While the need for a CS is important in addressing the care for every individual woman, every CS contributes to an increase in the CS rate. WHO used country-level data to show that, at a population level, maternal and neonatal mortality is not reduced any further when the CS rate increases above 10%.[1] Delivery by CS in South Africa (SA) is associated with severe complications and maternal deaths. In the Saving Mothers Report (2011 -2013), the institutional maternal mortality ratio (iMMR) was 66.6/100 000 live births for vaginal delivery v. an iMMR of 185.8/100 000 live births for delivery by CS in SA.[2] While it is difficult to separate the r...

A Retrospective Review of Decision to Delivery Time Interval for Foetal Distress at a Central Hospital

“…29,30 Also, interobserver interpretation of foetal heart rate for diagnosis of foetal distress has been shown to be only moderate 31 and when no specific standard guideline is followed to diagnose foetal distress, studies have shown that the sensitivity and specificity of CTG were also affected. 32,33 Our findings show an increase in foetal distress compared to a previous study in 2015 by Adam et al 34 at CHBAH, which found that foetal distress (49.7%) was the most common indication for caesarean delivery followed by dystocia and previous caesarean delivery. These findings are consistent with a study by Mittal et al, 35 which showed that foetal distress as an indication for emergency delivery was increasing annually.…”

“…Our findings show an increase in foetal distress compared to a previous study in 2015 by Adam et al 34 at CHBAH, which found that foetal distress (49.7%) was the most common indication for caesarean delivery followed by dystocia and previous caesarean delivery. These findings are consistent with a study by Mittal et al, 35 which showed that foetal distress as an indication for emergency delivery was increasing annually.…”

Maternal and fetal outcomes following delivery in a tertiary hospital in Johannesburg, South Africa

“…Improving hospital guidelines or training on interpretation of cardiotocographs may help to reduce CS for fetal distress. [17] Increased use of TOLAC could possibly help in reducing the size of group 5, as mentioned previously. Together, groups 6 and 7 contributed 4.7% to the overall CS rate.…”

“…A retrospective study conducted over 1 week at CHBAH in 2015 found that 8.16% of women who underwent CS had PPH, which is very similar to our rate of 8.3%. [17] To compare this with high-income countries, the International Postpartum Haemorrhage and Collaborative Group illustrated an increasing trend in PPH in immediate/atonic PPH in Australia, Canada and the USA, but this still only accounted for <7% of deliveries in all three countries in 2006. [18] Our high rates of PPH at CS may be related to our ratio of emergency to elective CS, our large numbers of CSes for previous CS, which are often more difficult surgeries, and the relative skill or seniority of the surgeon and anaesthetist attending the CS.…”

Maternal and neonatal outcomes following a diabetic pregnancy within the context ofHIV

“…17 However, macrosomia, PNM, and prematurity remain inferior to respective rates in South Africa for non-diabetic pregnancies. [18][19][20][21][22] The rate of cesarean delivery (n=641, 72.2%) was much higher in the present study than the estimated rate of cesarean delivery at CHBAH of 39.8% in non-diabetic pregnancies, 23 but only T A B L E 3 Comparison of baseline characteristics in metformin monotherapy and glibenclamide-exposed groups vs insulin monotherapy. moderately higher than the 1992-2002 audit of diabetic pregnancies (62%), a difference that could be due to an overall increase in rates of cesarean delivery over this period.…”