Abstract
Objectives: The objective of the study was to study the indications and risk factors for caesarean section (CS) and to study the caesarean rates in various patient groups as per Robson’s classification. Methods: This prospective observational study was conducted at Government Medical College Amritsar over a period of six months. All the patients admitted for delivery beyond 22 weeks were allotted to Robson groups on admission and the indications of all CS were recorded. The data collected were tabulated and analyzed statistically. Results: There were 553 deliveries in the study period, of which there were 241 CS amounting to a caesarean rate of 43.6%. Nulliparity, previous caesarean delivery and malpresentation were significant risk factors for CS but induction of labor was not associated with increased probability of caesarean delivery. Previous caesarean delivery was the most common indication of CS followed by foetal distress. Among Robson groups, group 10 had the biggest group size and biggest contribution to cesarean rates followed by group 5. Conclusion: Tertiary care government hospitals have a higher cesarean rates due to referral of high-risk pregnancies. Increasing the rates of trial of labour after caesarean is one of the interventions that may serve to decrease the caesarean rates in such institutions.
Highlights
The increasing caesarean rates across the globe have been a matter of serious concern as well as controversy
The WHO statement on caesarean rates in 2015, emphasized that when the caesarean rates at population level cross 10% of all deliveries, there is no significant benefit in terms of reduction in maternal and perinatal mortality rates [1]
We studied the most common indications for induction of labour and Caesarean Section (CS) from the indoor records of all patients
Summary
The increasing caesarean rates across the globe have been a matter of serious concern as well as controversy. The WHO recommends the use of Robson classification of all patients admitted for delivery in order to assess and compare, the cesarean rates and trends [3]. This classification assigns the pregnant women admitted for delivery to one of the ten distinct groups based on parity, onset of labor, number of foetuses, lie and presentation of the foetus and gestational age [4]. While groups one to nine are distinct, welldefined groups, all representing different risk factors for a CS, group ten is a rather heterogeneous group in which all pregnancies with less than 37 weeks gestation and single foetus in cephalic position are included irrespective of the parity and history of previous caesarean section
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