AN AUDIT OF CHANGE IN RATE AND INDICATIONS OF CAESAREN SECTION IN A TERTIARY CARE HOSPITAL OF PESHAWAR

Abstract

Objective: To compare the changes in rate and indications for caesarean section after a gap of ten years i.e., in 1996 and 2006 respectively.

Material and Methods: This comparative study was conducted in the Department of Obstetric and Gynecology at Lady Reading Hospital Peshawar in December 2006. Record of all the patients who delivered in Gynae B unit in 1996 and 2006 respectively was obtained. Out of all the deliveries, the details of the patients who had Caesarean section were recorded on a semi structured proforma which included the demographic details, gravidity and indication for which caesarean sections were performed. Statistical analysis was done by using SPSS version 10. Chi square test was performed for the comparison and a p value of <0.05 was considered significant for the study.

Results: During 1996, the caesarean section rate was 10.26% as compared to 25.10% in 2006 with a p value of <0.01 which was statistically significant for the increase in caesarean section rate. In 1996, the number of caesarean sections performed in multigravida were n=253 (59.81%), followed by grandmultigravida n=93(21.98%) while n=77 (18.20%) were performed in primigravida. In comparison, during 2006, highest number of caesarean sections were still performed in multigravida n=680(47.61%) but it was followed by primigravidas n=480(33.61%) and least n=268(18.76%) in randmultigravidas. During 1996, the commonest indications in order of frequency were dystocia n=120(31.20%), previous caesarean section n=71(16.78%), placenta praevia n=56(13.23%) and fetal distress n=48(11.34%) respectively while during 2006, they were dystocia 310(21.70%), fetal distress n=197(13.79%), previous caesarean section=191(13.37%) and breech presentation n=180(12.60%) respectively.

Conclusion: A significant increase (14.84%) in the rate of caesarean section in the last ten years is observed and it has gone particularly high in primigravidas in 2006. The main indications mostly were similar but malpresentations emerged as an important indication in 2006.