Tallat Iftikhar, Ume Salma Rizvi, Lubna Ejaz.
Evaluation of causes of increasing cesarean section rate in a tertiary care hospital.
J Sheikh Zayed Med Coll Jan ;1(1):7-10.

Background: Increasing cesarean section rate is a global phenomenon. There has been public health concern for last three decades about increasing cesarean section rate (CSR). Objective: The objectives of current study are; to determine cesarean section rate and enlist various factors causing increase in cesarean section rate in a tertiary care hospital. Patients and Methods: This descriptive study was conducted in Gynaecology and Obstetrics Department, of Holy family hospital, Rawalpindi, from 1st January to 31st December, 2008. Both booked and non booked patients for cesarean section were admitted through antenatal clinic and emergency department of this hospital. All the patients who underwent cesarean section were included in this study. Details on age, parity, antenatal care and indications for cesarean section were recorded on a proforma. Results: In our study, maternal age of the patients who had cesarean section ranged from 18 to 45 years. During this study total number of deliveries was 5941, normal vaginal deliveries were 3575 (60.1%), cesarean sections were 2026 (34%), assisted vaginal breech deliveries were 85 (1.43%) and instrumental deliveries were 255 (4.3%). Out of total number of deliveries, 3340 (56%) were booked patients and 2601 (44%) were non booked patients. In our study, it was observed that the most frequent indication for cesarean section was fetal distress 645 (32%), followed by repeat cesarean section 545 (27%). Conclusion: The CSR of 34% is higher in our study than the rate recommended by World Health Organization. The effective way to decrease the CSR is by proper antenatal evaluation, provision of continuous fetal monitoring to high risk cases, availability of senior obstetrician, and avoidance of unjustified inductions and promotion of vaginal breech delivery.

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