Caesarean section: its rates and indications at a tertiary referral center in Eastern Nepal

Abstract

Background: There has been a sustained increase in the rate of caesarean section in the last few years around the world. Data regarding the current caesarean rate and the trends of its indications in eastern Nepal have not been estimated earlier. Aim: To assess the rate of caesarean sections and the varying indications for caesarean section in a tertiary referral center in eastern Nepal. Methods: All hospital deliveries that took place in BPKIHS between January 2006 and December 2007 were recorded to assess the caesarean section rate and its indications. Results: A total of 5330 deliveries were conducted in 2006. Likewise the total number of deliveries conducted in 2007 was 6634. In 2006 caesarean sections were performed in 28.6% (1524) of all patients. The rate of caesarean sections in 2007 increased and was 33.7% (2239). The most common indication for caesarean section was meconiumstained liquor, which constituted 23.4% (883). The next frequent indication was previous caesarean section, which accounted for 17.2% (650), followed by breech presentation in 11.1% (417), fetal distress in 9.6% (364), non-progress of labor in 7.2% (270), cephalopelvic disproportion in 6.2% (234, and placenta previa in 4.4% (165). Conclusions: There is a increasing trend of performing cesarean section in the tertiary referral center in east era Nepal. The most common indication for cesarean section is meconium-stained liquor. Keywords: Caesarean section; caesarean delivery rates; Nepal DOI: http://dx.doi.org/10.3126/hren.v9i3.5587 HR 2011; 9(3): 179-183

Profile of Caesarean Section at Kathmandu Medical College

“…3 It may be due to fear of litigation, health insurance system, CS by choice, increased use of electronic monitoring of fetus, and increased proportion of breech deliveries by CS and deliveries in private set up. 1,3,6,[10][11][12] Our CSR was 45.81% (n=537) which is quite high when compared to similar studies done in Eastern Nepal by Chhetri et al 4 in 2007 of 33.7%. They also commented that increment was of 5% from the year 2006.…”

“…An obstetrician find repeat caesarean section much safer and convenient and is less likely to give rise to complication of scar dehiscence and possible subsequent litigation and maternal preference. [3][4][5][6] It is evident that where as CS is doctor friendly,VBAC is not. 6 Our institute may have similar reasons for practicing in cases of previous CS.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12] There might be various factors associated involved in the high CSR. 3 It may be due to fear of litigation, health insurance system, CS by choice, increased use of electronic monitoring of fetus, and increased proportion of breech deliveries by CS and deliveries in private set up.…”

“…9 However, some earlier studies from Nepal on hospital based data shows that cesarean section deliveries are increasing rapidly in eastern part of Nepal. 4 This present study was conducted to find out the rate and indication in our set up. This may be of help in adapting suitable measure to reduce CSR and problems associated with it.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12] Increase in CSR has been attributed to factors such as fetal monitoring with early detection of fetal distress, need for repeated cesarean section (CS), advancing maternal age at delivery, socioeconomic factors and changes in clinical management of labor. [1][2][3][4][5][6][7][8][9][10][11][12] Although CSR in many countries have increased from recommended level in both developed and many developing countries with increasing institutional deliveries due to growing access to gynecological and obstetrical care, the rate of delivery through cesarean section is relatively low in Nepal. 9 However, some earlier studies from Nepal on hospital based data shows that cesarean section deliveries are increasing rapidly in eastern part of Nepal.…”