RISING RATE OF CESAREAN SECTION-A YEAR REVIEW

Caesarean section is one of the most common surgeries performed in modern obstetrics. The rising trend of caesarean section in modern obstetrics is a major concern in health care system all over the world. With all the limited health care resources in a developing country like Nepal, this rising trend definitely has major implication. Rates of caesarean section countries in many countries have increased beyond the recommended level (WHO, 1985). Current available data from developed countries revealed morbidity and mortality from CS is more than in vaginal delivery for both the mother and fetus. Thus this study was conducted to evaluate the rate and indication for CS and to identify the measures to decrease its incidence if possible. Our results shows the foetal distress as the most common indication for Cesarean section in a eastern part of Nepal, which can be minimized significantly if a proper and timly investigation is carried out.


Introduction:
Caesarean section is one of the most common surgeries performed in modern obstetrics.Originally performed in interest of the mother, is now frequently done for foetal indication.Though it was introduced in clinical practice as a life saving procedure both for the mother and the baby.As other procedures of some complexity, its use follow s the health care inequity pattern of the world, underuse in low income setting, and adequate or even unnecessary use in middle and high income setting 1. Developing countries like Nepal are faced to the challenge of making the best use possible of limited resources to improve the health of women and children.Obstetrical intervention should be evidence based as mortality and morbidity due to unnecessary intervention could be hazardous.
The rising trend of caesarean section in modern obstetrics is a major concern in health care system all over the world 2 .With all the limited health care resources in a developing country like Nepal, this rising trend definitely has major implication.According to WHO, rates of caesarean section in many countries have increased beyond the recommended level of 15% 3, almost doubling in the last decade especially in high income areas like Australia, France, Germany, Italy, North America and United Kingdom 4,5,6,7.Similar trend is also seen in low resource countries like China, Brazil and India, especially due to births in private hospitals.Eventhough the indication of CS have not changed so far and these remain foetal distress, malpresentation, multiple gestation, previous caesarean, protracted labour and CS on demand.Current available data from developed countries revealed morbidity and mortality from CS is more than in vaginal delivery for both the mother and fetus.Thus this study was conducted to evaluate the rate and indication for CS and to identify the measures to decrease its incidence if possible.

Material and Methods:
This study was carried out in the department of Obstetrics and Gynaecology, Nobel Medical College, Biratnagar, with the aim to analyze the rate and indications for caesarean section.This study also aimed to provide a recommendation for health care professionals which may likely to reduce the rising trend of caesarean section as much as possible.With the objective to fulfil the aforementioned aims, this study was carried out in September 2010 to September 2011.All consecutive patients admitted to the Obstetrics and Gynaecology ward of Nobel Medical College, with history of pregnancy and labor pain, were included in the study.
Their demographic details of the patient were recorded including age, parity, address, socioeconomic status, period of gestation, stage of labour and fetal condition.

Results:
A total of 2011 deliveries were conducted in one year, out of which 1560(77.57%) were vaginal,400(19.89%)caesarean and 51 (2.53%) instrumental deliveries (Table 1).Regarding booking status of the patients, it was very low as most of the cases were referred from periphery and government hospital.(Table 2) The various indications of CS were shown in Table 5.This trend is also partly due to some evidence that suggests that planned caesarean birth might protect against urinary and faecal incontinence, pelvic organ prolapse and sexual dissatisfaction, further increasing its appea 19.

Conclusion:
The trend in performing caesarean section is increasing and the most common indication for Cesarean section is foetal distress and we should be more investigational to diagnose it as many of the cases didn't have any evidence of it intrapartum.

Table 5 : Indications of Cesarean Section
vaginal birth17..On demand CS rate being 1.25% in our set up.In West countries it is high and comprises of around 23% -38.9% in the United Kingdom18.