Primary Cesarean Section: A Gateway to Repeat Surgery : Primary Cesarean Section

Shagufta Tabassum; Faiza Suman; Ayesha Uzaima Tarin; Saima Ayaz Rao

doi:10.54393/pjhs.v6i5.2941

Authors

Shagufta Tabassum Department of Obstetrics and Gynecology, Nishtar Hospital, Multan, Pakistan
Faiza Suman Department of Obstetrics and Gynecology, Nishtar Hospital, Multan, Pakistan
Ayesha Uzaima Tarin Department of Obstetrics and Gynecology, Nishtar Hospital, Multan, Pakistan
Saima Ayaz Rao Department of Obstetrics and Gynecology, Nishtar Hospital, Multan, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i5.2941

Keywords:

Cesarean Section, Obstetric Indications, Maternal Outcomes, Delivery Trends

Abstract

The rising rate of Cesarean Sections (CS) is a significant concern globally. While C-sections are lifesaving in many cases, an increasing number of unnecessary procedures pose risks to both mothers and babies. It has been found that the most common indication of CS is previous CS. Objective: To assess the indications and the factors leading to primary CS. Methods: The study was conducted at a tertiary care hospital of Pakistan employing non-probability consecutive sampling. A detailed history of participants revolving around their first CS was taken including indication and the associated demographics. All the information was entered on a specific proforma. Data analysis was conducted using SPSS software version 26.0. The primary outcome variable was the indication for primary cesarean section, while the secondary variables included factors contributing to the procedure. Results: A total of 264 women who had CS for at least one of their pregnancy were considered. The vast majority (n=195, 73.9%) were primigravida, had 4-6 antenatal visits (n=174, 65.9%) and underwent CS at term (180, 68.2%). There were more emergency CS (n=140.53%) performed at private clinics/hospitals (n=201. 57.4%). Regarding the indications of primary CS, the most prevalent was failed progress of labour, followed by oligohydramnios, breech presentation/transverse lie, fetal distress, reduced fetal movements and maternal request. Conclusion: It is need of time to scrutinize the indications of primary CS and to adopt potential strategies to minimize its number with the aim to lower overall CS rate.

References

Haider S, Zahid HM, Nawaz A, Fatima M, Jamil B, Yousaf A et al. Robson Criteria to Determine the Risk of Cesarean Section in Females Presenting to Sir Ganga Ram Hospital (SGRH), Lahore: Robson Classification and Caesarean Section Rates. Pakistan Journal of Health Sciences. 2024 Jun: 94-8. doi: 10.54393/pjhs.v5i06.1841.

Antoine C and Young BK. Cesarean section one hundred years 1920-2020: the Good, the Bad and the Ugly. Journal of Perinatal Medicine. 2021 Jan; 49(1): 5-16. doi: 10.1515/jpm-2020-0305.

Betrán AP, Torloni MR, Zhang JJ, Gülmezoglu AM, Aleem HA, Althabe F et al. WHO statement on caesarean section rates. Bjog. 2015 Jul; 123(5): 667. doi: 10.1111/1471-0528.13526.

Boerma T, Ronsmans C, Melesse DY, Barros AJ, Barros FC, Juan L et al. Global epidemiology of use of and disparities in caesarean sections. The Lancet. 2018 Oct; 392(10155): 1341-8. doi: 10.1016/S0140-6736(18)31928-7.

Javed H, Ahmad TI, Adnan B. Cesarean Section Delivery in the Districts of Pakistan: Prevalence, Extent, and Correlates. Review of Applied Health Research. 2023 Dec; 1(1): 28-37. doi: 10.52131/rahr.2023.v1i1.2173.

Umar BU and Haque M. Growing concern over rising caesarean section rates: is it a problem for low-and middle-income countries only?. Advances in Human Biology. 2022 May; 12(2): 93-100. doi: 10.4103/aihb.aihb_148_21.

Turner MJ. Delivery after a previous cesarean section reviewed. International Journal of Gynecology & Obstetrics. 2023 Dec; 163(3): 757-62. doi: 10.1002/ijgo.14854.

Amjad A, Imran A, Shahram N, Zakar R, Usman A, Zakar MZ et al. Trends of caesarean section deliveries in Pakistan: secondary data analysis from Demographic and Health Surveys, 1990-2018. BioMed Central Pregnancy and Childbirth. 2020 Dec; 20: 1-3. doi: 10.1186/s12884-020-03457-y.

Jenabi E, Khazaei S, Bashirian S, Aghababaei S, Matinnia N. Reasons for elective cesarean section on maternal request: a systematic review. The Journal of Maternal-Fetal & Neonatal Medicine. 2020 Nov; 33(22): 3867-72. doi.org/10.1080/14767058.2019.1587407.

Ahmmed F, Manik MM, Hossain MJ. Caesarian section (CS) delivery in Bangladesh: A nationally representative cross-sectional study. PLOS One. 2021 Jul; 16(7): e0254777. doi: 10.1371/journal.pone.0254777.

Ardakani ZB, Navabakhsh M, Ranjbar F, Tremayne S, Akhondi MM, Tabrizi AM. Dramatic rise in cesarean birth in Iran: A coalition of private medical practices and womenâ s choices. International Journal of Women's Health and Reproduction Sciences. 2020; 8(3): 245-58. doi: 10.15296/ijwhr.2020.41.

Azmy J. 'SHE CAME THROUGH ME': Situating Birth Stories and Women's Embodied Wisdom in Folkloristics. Indiana University; 2023.

Dhakal-Rai S, van Teijlingen E, Regmi P, Wood J, Dangal G, Dhakal KB. Factors contributing to rising cesarean section rates in South Asian countries: A systematic review. Asian Journal of Medical Sciences. 2022 Feb; 13(2): 143-74. doi: 10.3126/ajms.v13i2.40904.

Khowaja B, Mughal FB, Valliani K. The factors influencing cesarean-section rates-a narrative review from Pakistan. Pakistan Journal of Medical Research. 2021 Oct; 60(3): 143-7.

Swannell C. Long term risks and benefits of caesarian deliveries. PLoS Med. 2018 Jan; 15(1): e1002494. doi: 10.1371/journal.pmed.1002494.

Saraya YS, Alashkar AH, Ali MA, Rajab AM, Saquib N. Indications and rate of first cesarean delivery in central region's maternity and children hospital. Saudi Medical Journal. 2019 Dec; 40(12): 1251. doi: 10.15537/smj.2019.12.24736.

Kanji Z, Simonovich SD, Najmi N, Bishop-Royse J. Examining clinical indications for cesarean section in a university hospital in Karachi, Pakistan. Journal of Asian Midwives (JAM). 2019 Sep; 6(1): 14-25.

Idris IM and Menghisteab S. Cesarean section delivery rates, determinants, and indications: a retrospective study in Dekemhare Hospital. Global Reproductive Health. 2022 Apr; 7(1): e56. doi: 10.1097/GRH.0000000000000056.

Aftab S, Ali N, Saleh F, Ghafoor SG, Mahesh A, Memon S. Indications of primary cesarean section in multipara. Journal of Bahria University Medical and Dental College. 2019 Jun; 9(2): 105-8. doi: 10.51985/JBUMDC2018117.

Trahan MJ, Czuzoj-Shulman N, Abenhaim HA. Cesarean delivery on maternal request in the United States from 1999 to 2015. American Journal of Obstetrics and Gynecology. 2022 Mar; 226(3): 411-e1. doi: 10.1016/j.ajog.2021.10.003.

Birla S, Gupta M, Birla P, Sharma J. Comparison of incidence, indication and complication of primary cesarean section in primigravida and multigravida. International Journal of Medical Science and Education. 2016 Jul; 3(3): 311-7.