Analysis of primary cesarean sections in NTSV (Nulliparous, Term, Single, Vertex) in a tertiary care hospital in South India

Abstract

Introduction and Aim: Globally, rising caesarean section rates have become public health concern. Cesarean section analysis and audits using Robson ten group classification system have identified the main drivers of Cesarean section rates (CSR) are the gravidas with previous CS and the nulliparous with term singleton foetus with vertex presentation (NTSV).1-10 Given the low rates of vaginal birth after a cesarean section, once a woman undergoes her first CS, she is extremely likely to have repeat CS in subsequent pregnancies. This increases the burden of high risk pregnancies and increased CS rates subsequently. Reducing primary cesarean sections in NTSV is the key for improving overall health statistics of the institutions. Hence, this one year prospective study was conducted to know the factors contributing to CS in NTSV population in a tertiary care hospital in South India. Materials and Methods: The study is prospective observational study which is conducted in labour wards of department of Obstetrics & Gynaecology at teaching hospital attached to KLE Academy of Higher Education’s Jawaharlal Nehru Medical College, Belagavi, from January 2016 to December 2016. Results: Total number of gravidas who delivered during study period, were 6236, out of which 2494 (40%) were NTSVs. The CS among NTSVs were found to be 849(34.01%). The main indications for emergency cesarean sections in NTSV were fetal distress, non-progress of labour, failed induction i.e. 44.76%, 16.65% and 15.31%, respectively. Conclusion: The primary cesarean sections among the NSTV is an important contributor to the overall cesarean sections of the health institute. The main indications of CS were fetal distress, non-progress of labour and failed induction. There is a need to develop standard clinical protocols for management of these conditions and emphasise vaginal delivery in NTSVs. Also strategies like training the obstetricians in interpretation and management of suspicious and non-reactive