AUDIT OF CLINICAL INDICATIONS FOR PRIMARY CESAREAN SECTION IN A TERTIARY CARE HOSPITAL

N QAYYUM; N REHMAN; A AMJAD; H HASSAN; T BIBI; SHAHINDA .; SH SHAH

doi:10.54112/pjicm.v5i02.138

Authors

N QAYYUM Department of Obstetrics & Gynae, Khyber Teaching Hospital, Peshawar, Pakistan
N REHMAN Department of Obstetrics & Gynae, Khyber Teaching Hospital, Peshawar, Pakistan
A AMJAD Department of Obstetrics & Gynae, Lady Reading Hospital, Peshawar, Pakistan
H HASSAN Department of Obstetrics& Gynae, Javed Medical Complex, Peshawar, Pakistan
T BIBI Department of Obstetrics & Gynae, Khyber Teaching Hospital, Peshawar, Pakistan
SHAHINDA . Department of Obstetrics & Gynae, Hayatabad Medical Complex, Peshawar, Pakistan
SH SHAH Department of Obstetrics & Gynae, Khyber Teaching Hospital, Peshawar, Pakistan

DOI:

https://doi.org/10.54112/pjicm.v5i02.138

Keywords:

Primary Cesarean Section, Clinical Audit, Fetal Distress, Labor Dystocia, Obstetric Outcomes, Partograph Utilization

Abstract

Background: Cesarean section (CS) rates are rising globally, with primary cesarean deliveries contributing substantially to maternal and neonatal morbidity. Identifying the leading indications and evaluating labor management practices is essential to improving obstetric care and reducing unnecessary procedures. Objective: To assess the indications for primary cesarean section in a tertiary care hospital. Study Design: Clinical audit. Setting: Department of Obstetrics and Gynecology, Khyber Teaching Hospital, Pakistan. Duration of Study: January 2025 to June 2025. Methods: A total of 150 cases of primary cesarean delivery were prospectively enrolled. Data were collected using standardized case record forms documenting demographic characteristics, labor progression parameters, fetal monitoring methods, surgical indications, and maternal and neonatal outcomes. Statistical analysis was performed using descriptive methods and comparative assessment of labor management practices. Results: Emergency cesarean sections accounted for 80.7% of cases. Fetal distress (41.3%) and VBAC (35.3%) were the most common indications, followed by breech presentation and failed induction. Incomplete partograph documentation was observed in 71.3% of cases, and fetal monitoring methods varied across patients. Maternal complications occurred in 12.0% of cases, while neonatal outcomes revealed 11.3% with low Apgar scores and 10.7% requiring NICU admission. Comparative analysis highlighted significant inconsistencies in the diagnosis of fetal distress and labor management approaches. Conclusion: Fetal distress and VBAC were the leading indications for primary cesarean delivery. The findings underscore the urgent need for standardized fetal monitoring protocols, consistent partograph utilization, and improved labor management strategies to optimize maternal and neonatal outcomes and reduce unnecessary cesarean sections.

References

Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021;6(6):e005671. https://doi.org/10.1136/bmjgh-2021-005671

Visconti F, Quaresima P, Rania E, Palumbo AR, Micieli M, Zullo F, et al. Difficult caesarean section: A literature review. Eur J Obstet Gynecol Reprod Biol. 2020;246:72–8. https://doi.org/10.1016/j.ejogrb.2019.12.026

Gedefaw G, Demis A, Alemnew B, Wondmieneh A, Getie A, Waltengus F. Prevalence, indications, and outcomes of caesarean section deliveries in Ethiopia: a systematic review and meta-analysis. Patient Saf Surg. 2020;14:11. https://doi.org/10.1186/s13037-020-00236-8

Angolile CM, Max BL, Mushemba J, Mashauri HL. Global increased cesarean section rates and public health implications: A call to action. Health Sci Rep. 2023;6(5):e1274. https://doi.org/10.1002/hsr2.1274

ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery. Obstet Gynecol. 2019;133(2):e110–e127. https://doi.org/10.1097/AOG.0000000000003078

First and Second Stage Labor Management: ACOG Clinical Practice Guideline No. 8. Obstet Gynecol. 2024;143(1):144–162. https://doi.org/10.1097/AOG.0000000000005447 .

Franz MB, Husslein PW. Obstetrical management of the older gravida. Womens Health (Lond). 2010;6(3):463–8. https://doi.org/10.2217/whe.10.26

Guihard P, Blondel B. Trends in risk factors for caesarean sections in France between 1981 and 1995: lessons for reducing the rates in the future. BJOG. 2001;108(1):48–55. https://doi.org/10.1111/j.1471-0528.2001.00009.x

Belizán JM, Althabe F, Cafferata ML. Health consequences of the increasing caesarean section rates. Epidemiology. 2007;18(4):485–6. https://doi.org/10.1097/EDE.0b013e318068646a

Villar J, Carroli G, Zavaleta N, Donner A, Wojdyla D, Faundes A, et al. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ. 2007;335(7628):1025. https://doi.org/10.1136/bmj.39363.706956.55

Potter JE, Hopkins K. Consumer demand for caesarean sections in Brazil: Demand should be assessed rather than inferred. BMJ. 2002;325(7359):335. https://doi.org/10.1136/bmj.325.7359.335

National Collaborating Centre for Women’s and Children’s Health (UK). Caesarean section. London: RCOG Press; 2011. (NICE Clinical Guideline CG132). No DOI assigned. Available from: https://www.nice.org.uk/guidance/cg132

Thool KN, Jain SM, Shivkumar PV, Jain MA, Podder MR. A clinical audit and confidential enquiry of caesarean section indications at a rural tertiary health care centre. Int J Reprod Contracept Obstet Gynecol. 2017;6(4):1478–83

Peng FS, Lin HM, Lin HH, Tu FC, Hsiao CF, Hsiao SM. Impact of clinical audits on cesarean section rate. Taiwan J Obstet Gynecol. 2016;55(4):530–3. https://doi.org/10.1016/j.tjog.2014.12.015

Dekker L, Houtzager T, Kilume O, Horogo J, van Roosmalen J, Nyamtema AS. Caesarean section audit to improve quality of care in a rural referral hospital in Tanzania. BMC Pregnancy Childbirth. 2018;18:164. https://doi.org/10.1186/s12884-018-1814-1

Sheikh L, Tehseen S, Gowani SA, Bhurgri H, Rizvi JH, Kagazwala S. Reducing the rate of primary caesarean sections—an audit. J Pak Med Assoc. 2008;58(8):444–8.