DETERMINANTS OF PRIMARY CAESAREAN DELIVERY AND ITS OUTCOME IN SOUTH KERALA
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2018, Vol 5, Issue 34
Abstract
BACKGROUND Caesarean Delivery is one of the most common surgical intervention in modern obstetrics. It is certainly one of the oldest operations in surgery, with its origin lost in antiquity and ancient mythology. Caesarean birth has been the most common hospital-based operative procedure in many parts of the world. An operation mainly intended to save a maternal life during difficult childbirth has now increasingly become the procedure of choice in high risk situations to prevent perinatal mortality and morbidity. The incidence of Caesarean section has doubled or tripled all over the world over the past 2 decades. Justification for this trend is the lowering of maternal mortality to the point of nil and increasing survival as compared to difficult vaginal deliveries. WHO1 endorsed that a caesarean delivery rate more than 10 to 15% is not justified in any region of the world. One of the ways that we could adopt to reduce the caesarean delivery rates would be to cut down the primary caesarean rates. So, in this study, we have analysed the determinants of primary caesarean delivery and their outcomes (maternofoetal) in a tertiary care teaching hospital in South Kerala. Objectives of the study are- 1) To find out the determinants of Primary Caesarean (Sociodemographic, Obstetric, Medical, Foetal and Physician factors). 2) To evaluate the maternal and foetal outcomes of Primary Caesarean Delivery. MATERIALS AND METHODS Study Design- Case Control Study. This study was conducted in 900 subjects (450 cases & 450 controls) in the Department of Obstetrics and Gynaecology, Sri Avittom Tirunal Hospital, Thiruvananthapuram over a period of six months. Study Variables- Age, Sociodemographic Data, Source of Referral, Antenatal Risk Factors, Maternal Anthropometry, Indication of Caesarean Delivery, Birth Weight of Baby, Maternal Postoperative Morbidities, NICU Admissions and Neonatal Details were noted. RESULTS The mean age of the case group was 25.3 and 24.21 in the control group. Primipara are 1.96-fold more likely to undergo caesareans. Women having medical disorders had 3.587-fold chance of operative intervention. Bad Obstetric History mothers had 1.68 times more chance of abdominal delivery. Coming to maternal anthropometry, women more than 70 kgs had 4.2 times more risk of first time caesarean. In labour referrals and women with infertility, treatment had higher chance of operative delivery. Maternal indications like Failed induction (21%), Dystocia (16%) Maternal medical disorders (15%), followed by foetal indications (14%) and IUGR (13%) made up majority of primary caesareans. Commonest morbidity was maternal fever. Babies of Primary caesarean mothers had 2.9 times more chances of NICU admissions. Preterm admissions were 16 times more common than term admissions. Apgar at 1 minute and 5 minutes was significantly lower in the babies of the case group than that of the control group. CONCLUSION Definite protocols to control unjustified and unnecessary induction of labour and availing second opinion in decisions during dystocias in labour can definitely reduce Primary Caesarean delivery rates. Thus, by bringing down the Primary caesarean delivery rates, we can indirectly reduce the burden of Repeat Caesarean Deliveries and its morbidities and thereby improve women’s health.
Authors and Affiliations
Heera Shenoy T. , Sheela Shenoy T
Keywords
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- EP ID EP571079
- DOI 10.18410/jebmh/2018/513
- Views 99
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