Determinants of caesarean section in a tertiary hospital

Objective: To analyse the different indications and frequency of caesarean sections in order to reduce such deliveries in a tertiary hospital. Methods: The retrospective study was conducted at the Department of Obstetrics and Gynaecology, Liaquat National Hospital, Karachi, from January 1 to December 31, 2011. It comprised review of clinical records of all patients who underwent caesarean section during the period. This included booked, un-booked or referred cases and data regarding the indications, type of caesarean deliveries and demographic features as well as outcomes. SPSS 13 was used statistical analysis.Results: During the study period, there were 1491 deliveries out of which 669 (44.8) were caesarean. Emergency caesarean section was performed on 392(58.5%) and elective caesarean section was performed on 277(41.4%) patients. Overall, 523(78.2%) cases were booked and 146(21.8%) were un-booked or referred cases. Most of the caesarean sections were carried out due to previous caesarean sections 207(30.9%) followed by foetal distress 102(15.2%), non-progress of labour 93(13.9%), malpresentation 44(6.57%), placental abruption 21 (3.13%) and placenta previa 19(2.84%). Conclusion: Audit and feedback is the best way to judge clinical practice and to reduce the frequency of caesarean section in any tertiary setup. Previous caesareans were the most common indication of repeat procedure in the study.