Abstract
Objective:To analyze the Caesarean Section (CS) rate among different groups of consultants dealing with Nulliparous Term Singleton pregnancy with Vertex (NTSV) presentation delivering at a tertiary care hospital of Karachi over four months.Methods:This is a secondary analysis of a retrospective data that analyzed factors affecting the CS-rate of NTSV patients. Patients with CS (n=106) were taken as cases and vaginal deliveries (n=106) as controls. This was an unmatched retrospective case-control study.Results:Mean age of patients was 26.6(SD: 4.2) years. Mean gestational-age was 38.6(SD: 1.0) weeks. Likelihood of CS was slightly less in patients who were attended by feto-maternal consultants(OR:0.81 CI:0.38-1.07) and was slightly more in patients managed by non-full-time faculty (OR:1.04 CI:0.59-1.85). Odds of CS was highest amongst consultants having average monthly volumes of 21-30 patients/month (OR:1.069 CI:0.48-2.34). However none of the above findings were statistically significant. A non-significant increase in risk of CS was observed with increase in experience of physicians (p=0.787).Conclusion:The results did not show statistically significant difference in CS rate among different groups of Obstetricians. This might indicate that managing labour according to standard guidelines can eliminate physicians’ bias. This can be further evaluated with larger multicenter prospective studies.
Highlights
Increasing Caesarean Section (CS) rates are of great concern all over the world.[1]
Total of 212 patients were enrolled. This included 106 patients delivered through CS, taken as cases compared with equal number of vaginal deliveries, taken as controls
FT faculty dealt with 67.5% of cases while 32.5% were delivered by NFT consultants
Summary
Increasing Caesarean Section (CS) rates are of great concern all over the world.[1] This imparts increased risk to mothers’ health and life when compared to vaginal deliveries, with no added benefits to fetus. Literature indicates different reasons of rising CS rate. These include increasing rates of labor inductions[2], inclination of patients for CS, lesser chances of litigation, easy scheduling, and subjectivity of providers’ decision during labour.[3,4,5] In order to modify the practices and other factors affecting the mode of delivery (MOD) many centers use CS rate as a quality indicator especially among Nulliparous at Term and Singleton pregnancies with Vertex presentation (NTSV).[6] The rate of CS among NTSV varies widely, from 10.3%
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