Maternal and Perinatal outcome of 4000 consecutive cases of caesarean section

Prasanna Lakshmi, S (2007) Maternal and Perinatal outcome of 4000 consecutive cases of caesarean section. Masters thesis, Madras Medical College, Chennai.

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Abstract

AIM OF THE STUDY: The aim of the study is to know: 1. The current incidence of the caesarean section. 2. The common indications of caesarean section. 3. Maternal mortality and morbidity following caesarean section. 4. Perinatal mortality and morbidity following caesarean section. MATERIALS AND METHODS: 4000 consecutive cases of caesarean section done at Institute of Obstetrics and Gynaecology, Chennai between November 2005 and June 2006 were followed prospectively till discharge from the Hospital to find out the indications for the operation and the maternal and fetal outcome. Data relating to caesarean section, Maternal mortality following caesarean section, and over all perinatal mortality during the years 2001-2005 were obtained from the medical records department, Institute of Obstetrics and Gynaecology, Chennai. SUMMARY: 1. Consecutive 4000 cases of caesarean section performed between 2005 – 2006 were analysed. The incidence of caesarean section was 37.66%. 2. Maximum patients were in the age group of 21-25 years. 3. Most of the patients were primiparas and second paras. The incidence of caesarean in primi in emergency caesarean section was 69.16% and in elective caesarean section was 55.93%. 4. Repeat section contributed to 37.88% of caesarean section and 62.12% were primary section. 5. The common indications were previous caesarean section as the primary indication 25.05%. Next was fetal distress contributing to 21.6% followed by cephalopelvic disproportion 17.58% and Breech presentation 4.47%. 6. The maternal morbidity was 6.25% and maternal mortality was 0.3% in our study. 7. The perinatal morbidity rate was 5.8% and mortality rate was 2.65% in our study. CONCLUSION: The steady rise in caesarean section rates is an area of concern in mother – child health care and a matter of international attention. Monitoring time – trends in caesarean section rates has been considered a useful approach in recognition of this rapidly changing health policy and in estimating the magnitude of this problem. The incidence of caesarean section has doubled or tripled all over the world in the last 15 years. Justification for this trend is, the lowering of maternal mortality almost to the point of nil and increasing fetal survival as compared to difficult vaginal deliveries. The past decade has noticed an increasing preference to Caesarean deliveries. Historically, as caesarean section rates had crossed the 15% mark that the World Health Organisation had suggested as an upper limit, focus is on determining the extent to which the increase is driven by medical indications. The appropriate use of caesarean section, like the appropriate use of any medical intervention, should be based on risks and benefits. Caesarean section rates are increasing and most of them hold the media and women responsible for this rising trend. Though the rates have been increasing all over the world and in our country, there was a decrease in the caesarean section rate by 3% in the last year (2005) from 43.50% to 40.28% in our institute. The caesarean section rate in our study was 37.66%. This decrease in the caesarean rate by 2.34% is entirely attributed to the increase in vaginal birth after caesarean section in the last year. Another reason for decrease in caesarean rate being establishment of 24 hours Comprehensive Emergency Obstetric and New Born Care Services at secondary level health institutions. The maternal mortality rate has increased slightly from 0.14% in 2004 to 0.29% in 2005. In our study there has been an increase by 0.01%, this has been attributed to the late referrals received at our institute in moribund condition. Though the Corporation Hospital, Taluk Head Quarters and District, Head Quarters Hospital are provided with comprehensive heath care round the clock and blood bank facilities, moribund patients are referred to us due to ventilator facilities available at our institute. The quality of referral system is crucial for preventing maternal death. The hierarchy of maternity facilities only becomes a functioning unit if the referral system from the lower order health centre to the referral unit is efficient and effective. The perinatal mortality rate remained the same at 2.65% (post LSCS) despite the decrease in caesarean section rate, where one expects an increase in perinatal mortality rate. There is a ‘caesarean birth epidemic’ or rather a ‘pandemic’ emerging issue in mother-child health care. The rising caesarean section rates in our state, country and world over deserves international attention. This also has a bearing on the socioeconomic structure of the individual and the society since immediate and long-term need for absenteeism for work puts an additional burden on the already weak women of low socioeconomic group. Our observation has also shown that primary caesarean section plays an important role in repeat caesarean sections. Hence judicious decision making for primary caesarean section will go a long way in reducing the caesarean section rate in future. Better understanding and training in allowing vaginal birth after caesarean section will also help to reduce the spiraling caesarean section rates. Individualization of every case, meticulous clinical examination, use of intrapartum feto-maternal surveillance along with regular use of partogram would limit the practice of caesarean section. Obstetric audits, following standardized guidelines and practice of evidence based medicine will help us a lot in reducing the rate of caesarean section.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Maternal and Perinatal outcome ; 4000 consecutive cases ; caesarean section.
Subjects: MEDICAL > Obstetrics and Gynaecology
Depositing User: Subramani R
Date Deposited: 03 Dec 2017 10:54
Last Modified: 09 Dec 2017 01:41
URI: http://repository-tnmgrmu.ac.in/id/eprint/4165

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