Indications and Rate of Caesarean Section- Changing Trends

Objective: To determine and compare the rate and indications for caesarean section at four year interval. Method: Retrospective analysis of caesarean sections done in 2003 and 2007.  Results: An increase in the rate of caesarean section was found from 20.03% (1164/5810) in 2003 to 23.80% (1492/6269) in 2007. In 2003 versus 2007, foetal distress [ 42.96% ( 500/1164 ) vs 38.94% ( 581/1492 ) ], previous history of caesarean section [ 13.57% ( 158/1164 ) vs 24.73% ( 369/1492 ) ], breech [ 9.11% (106/1164) vs 8.51% ( 127/1492 ) ] and non progress of labour [ 5.67% ( 66/1164 ) vs 5.70% (85/1492 ) ] formed the main indications. 58.85% (685/1164) vs 57.84% (863/1492) sections were done in primiparas. In those with fetal distress, no cause of distress was found in 68.20% ( 341/500 ) vs 72.63% ( 422/581 ) patients, meconium in 24.40% ( 122/500 ) vs 15.83% ( 92/581 ), loop of cord around the neck in 2% ( 10/500 ) vs 9.47% ( 55/581 ) and decreased liquor in 5.40% (27/500 ) vs 2.07% ( 12/581 ) of the patients. Intact scar was found in 87.80% patients with previous section operated for various indications as meconium stained liquor, scar tenderness, maternal tachycardia and previous history of two or more than two caesarean sections. Conclusion: A significant increase was found in caesarean sections in those with previous history of caesarean section (11.16%). Majority of caesarean sections were done in primiparas and fetal distress formed the main indication. A 4.02% decrease was found in sections done for fetal distress. No statistically significant difference was found in rate of sections done for breech and non progress of labour