Findings Related to C-Section Rates: Using Cesarean Indication Classification System

Abstract

A retrospective study to assess the indications of cesarean section (C-section) using Modified Cesarean Indication Classification System (CICS) among health facilities in selected areas of New Delhi was conducted. C-section is one of the commonly performed surgical procedures in obstetric and is certainly one of the oldest operations in surgery. Recently, there has been a dramatic rise in the C-section rate (CSR) worldwide as primary cesarean deliveries contributed most to the overall CSR. The main aim of the study was to find out the number of C-sections and the indications based on absolute and non-absolute indications by using modified cesarean indication classification system. As the nursing perspective about the hospital birth, nurses are the major and central part for the management of labor and delivery units. Even nurses are the ones who are largely responsible for the mothers in their antenatal, intranatal and postnatal period. Nurses are the administrators and decision makers and can assess the outcome of second stage of labor, and they can assess for indications of C-section. A retrospective survey was done for collecting data. The data was collected from the medical records of mothers who had undergone C-section between January and September 2017 in four health facilities of New Delhi. The findings of the present study revealed that the average rate of C-section among four health facilities was 20.9%. Among the absolute indications, obstructed labor ranked first and maternal distress ranked the least, and among the non-absolute indications, fetal compromise ranked first and Rhesus incompatibility ranked the least. The most commonly recorded indications from across all the four health facilities were obstructed labor, severe preeclampsia/eclampsia, malpresentation, previous cesarean delivery, and fetal compromise. Regarding mortality after C-section, in health facility A, out of 1451 mothers who underwent C-section, 3.51% died after C-section; in health facility B1, out of 1310 mothers, 3.37% died after C-section; in health facility B2, out of 178 mothers who underwent C-section, the mortality was 3.37%; and in health facility C, out of 426 mothers, the mortality was 3.05. Regarding morbidity due to C-section, in health facility A, out of 1451 mothers who underwent C-section, 8 mothers developed morbidity due to C-section. Out of the 3365 C-sections assessed, 27 women had undergone C-section without taking consent. The study results suggested that increased standardization in indicator terminology is needed to enable meaningful monitoring and comparison of trends using an indication system. Nearly all files included in this review had a recorded indication; however, many indications were difficult to categorize because of the limited information included. Analysis of this data was also complex because of the varying terminologies across settings. Periodic reviews (quarterly/annually) of cesarean indications should be a core component of quality improvement efforts in safe motherhood. Strategies should be adopted in health facilities to charge the same amount for C-sections as natural deliveries.