Prevalence and Indications of Cesarean Section in a Community Hospital of Western Region of Nepal

Chaudhary, Rajendra; Raut, Krishna Bahadur; Pradhan, Kristina

doi:10.31729/jnma.3760

Cited by 11 publications

(16 citation statements)

References 14 publications

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“…The most common indication for CS in community hospital in Pokhara is oligohydromnos, 23.56%. 5 However our study revealed that the most common indication in our centre was previous caesarean section which was similar to the study done in Kathmandu Medical College (KMC) by Apurwa Prasad et al 6 Current medical literature suggests that 60-80% of women can achieve vaginal delivery. 7 Sharma et al in their studies found indication of repeat elective caesarean section was refusal of trial of scar, when the women were told about risk associated with trial of scar like uterine rupture, scar dehiscence and bleeding due to adherent placenta.…”

Section: Discussionsupporting

confidence: 87%

“…Similar study done at a community hospital of western region of Nepal found CS rate as 63.27%, which was quite high as compared to our study. 5 The rate of CS at our hospital was also slightly higher than other district level hospitals or Comprehensive Emergency Obstetric and Neonatal Care(CEONC) center. This may be because our hospital is located in Pokhara, which is among of major cities in Nepal.…”

Section: Discussionmentioning

confidence: 63%

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Prevalence of Caesarean Section in Matri Shishu Miteri Hospital of Gandaki Province

Pageni

Adhikari

Dhungana

et al. 2020

Med. J. Pokhara Acad. Health Sci.

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Background: Caesarean section (CS) is one of the commonest obstetrics procedure to reduce the risks for mother and fetus when vaginal delivery is not anticipated. The objective of the study was to determine the rate and clinical indication of Caesarean section. Materials and Methods: This was a hospital based descriptive retrospective study done within a time frame of a year (from Shrawan 2075 BS to Ashad 2076 BS; 17 July 2018 to July 16 2019) in Matri Shishu Miteri Hospital, Pokhara, Nepal. The total number of deliveries, their modes of delivery, indication for the Cesarean section, age group, number of parity, period of gestation and type of Caesarean section either elective or emergency were descriptively analyzed. Results: A total of five hundred and eighty eight cases underwent delivery during the study period. Of them 128 (21.76%) cases were delivered by Caesarean section. Analysis revealed that the common age group for the CS patients was between 20-30 years (64.8%) of them 66 (51.6%) cases were primi gravida. Emergency Caesarean section was done for 75(58.6%) cases and elective Caesarean section for 53(41.4%) cases. The most common indication for Caesarean section was found to be previous caesarean section 21% (n=27), cephalopelvic disproportion (CPD) 18% (n=23), fetal distress 18% (n=23), failed induction 14.1% (n=18), breech presentation 10.2 %( n=13), non progress of labor (NPOL) 9.4 %( n=12) and oligohydramnios 7.8% (n=10). Conclusion: Our study revealed that the rate of Caesarean section is higher than that recommended by World Health Organization (WHO), which needed to be 10-15% of the total deliveries. The common indications for Caesarean sections were pervious Caesarean section, fetal distress, CPD, failed induction, breech presentation, non progress of labour (NPOL) and oligohydramnios among others.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 63%

Prevalence of Caesarean Section in Matri Shishu Miteri Hospital of Gandaki Province

Pageni

Adhikari

Dhungana

et al. 2020

Med. J. Pokhara Acad. Health Sci.

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“…Delivery is a completely natural process that requires preventive and supportive measures. Normal delivery applies to mothers who are unable to perform it, otherwise, a cesarean section may be used in cases where childbirth is not possible or if it may pose risks to the mother and infant (1). Over the past few decades, cesarean sections have increased dramatically around the world, causing concern for public health officials (2).…”

Section: Introductionmentioning

confidence: 99%

Effect of Low-Dose Intravenous Ketamine on Prevention of Headache After Spinal Anesthesia in Patients Undergoing Elective Cesarean Section: A Double-Blind Clinical Trial Study

et al. 2019

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Background: Spinal anesthesia is the most commonly used method for elective cesarean section, which is a popular technique due to its simplicity, reliability, and speed to achieve adequate anesthesia. Headache following dura perforation is the most important delayed complication following spinal and epidural anesthesia. Objectives: To evaluate the impact of low-dose intravenous ketamine in patients undergoing cesarean section under spinal anesthesia on the prevention of dura perforation headache (PDPH). Methods: This clinical trial study was performed on 64 pregnant women undergoing cesarean section at Vali-e-Asr Hospital. The patients were divided into two groups. In the case group, 0.15 mg/kg body weight ketamine was injected intravenously and in the control group, normal saline was used as the placebo. The incidence of headache and its severity at one, 4, 12, and 24 hours postoperatively, nausea and its severity were also measured and compared. Independent t-test, Mann-Whitney U and chi-square tests were used. A P value < 0.05 was considered statistically significant. Results: The data revealed that low dose intravenous ketamine significantly decreased patients' headaches (P = 0.001), the sensation of pruritus (P = 0.009), and the need for analgesic (P = 0.001). Furthermore, the sensation of postoperative nausea was less in the case group. The patients in the case and control groups had no significant difference in terms of hypertension or bradycardia (P = 0.717 and 0.939, respectively). Conclusions: The injection of ketamine as a premedication in the cesarean section can reduce the severity of postoperative headache in mothers. Therefore, it is recommended to use ketamine as an anti-headache drug in pregnant women.

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“…Of the total births in Nepal in 2016, CSs accounted for 9%, but with large discrepancies depending on women's educational level (5% among women with no education vs. 20% among women with secondary level education), wealth (2% among women in the lowest wealth quantile vs. 28% in the highest), and type of facility (12% in public facilities vs. 35% in private) [33]. Hence, many researchers argue that there might be an overuse of CS in some facilities in Nepal and that this needs to be investigated in further detail [9,34,35].…”

mentioning

confidence: 99%

“…Most previous research to assess accuracy of CS indications, in Nepal as well as other low-resource settings, have been based at one facility and included relatively small sample sizes [5,6,8,12,34]. It has been reported that the majority of stillbirths and cases of neonatal encephalopathy in Nepal are associated with intrapartum hypoxia and suboptimal care [36], and that there is a lack of proper FHRM and partograph use in Nepali hospitals [27].…”

mentioning

confidence: 99%

Disclosing suboptimal indications for emergency caesarean sections due to fetal distress and prolonged labor: a multicenter cross-sectional study at 12 public hospitals in Nepal

Litorp

Gurung

2020

Reprod Health

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Background Global caesarean section (CS) rates have raised concern of a potential overuse of the procedure in both high- and low-resource settings. We sought to assess management and outcomes of deliveries with emergency CSs due to fetal distress and prolonged labor at 12 public hospitals in Nepal and determine factors associated with suboptimal CS indications. Methods We conducted a cross-sectional study on all deliveries between the 14th of April 2017 and the 17th of October 2018 at 12 public hospitals in Nepal and included all emergency CSs due to fetal distress and prolonged labor. Analysis was conducted using Pearson chi-square test and bivariate and multivariate logistic regression. Results The total cohort included 104,322 deliveries of which 18,964 (18%) were CSs (13,095 [13%] emergency CSs and 5230 [5.0%] elective CSs). We identified 1806 emergency CSs due to fetal distress and 1322 emergency CSs due to prolonged labor. Among CSs due to fetal distress, only 36% had fetal heart rate monitoring performed according to protocol, and among CSs due to prolonged labor, the partograph was completely filled in only 8.6%. Gestational age < 37 weeks and birth weight < 2500 g were associated with more suboptimal CS indications due to fetal distress (adjusted odds ratio [aOR] 1.4, 95% confidence interval [CI] 1.1–1.8 and aOR 1.7, 95% CI 1.3–2.2 respectively) than those with gestational age > 37 weeks and birth weight > 2500 g. We found no association between suboptimal CS indications and maternal ethnicity or education level. Conclusions As fetal heart rate monitoring and partograph are fundamental to diagnose fetal distress and prolonged labor, the inappropriate monitoring proceeding CS decisions disclosed in our study indicate that CSs were performed on suboptimal indications. We call for improved quality of intrapartum monitoring, enhanced documentation in medical records, and structured auditing of CS indications in order to curb the potentially harmful CS trend.

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Prevalence and Indications of Cesarean Section in a Community Hospital of Western Region of Nepal

Cited by 11 publications

References 14 publications

Prevalence of Caesarean Section in Matri Shishu Miteri Hospital of Gandaki Province

Prevalence of Caesarean Section in Matri Shishu Miteri Hospital of Gandaki Province

Effect of Low-Dose Intravenous Ketamine on Prevention of Headache After Spinal Anesthesia in Patients Undergoing Elective Cesarean Section: A Double-Blind Clinical Trial Study

Disclosing suboptimal indications for emergency caesarean sections due to fetal distress and prolonged labor: a multicenter cross-sectional study at 12 public hospitals in Nepal

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