CAESAREAN SECTION: TIME TREND AND RISK FACTORS

Introduction

esarean section (CS), also known as c-section or caesarean delivery, is the surgery to deliver babies¹. Cesarean delivery is one of the most common surgeries performed in modern obstetrics. The surgery is intended to save the lives of mother and newborn².  Cesarean sections are performed for various fetal and maternal indications; these include labor and delivery abnormalities, placental and cord abnormalities, and repeated CS deliveries. Recently, CS has been performed to satisfy women’s desire; therefore, cesarean delivery on maternal request was added to the known common CS indications³.  Over several decades, a dramatic increase in the number of Caesarean sections performed across the world, especially in developed countries. The frequency of Caesarean section increased from 5% to 15%. However, the rate of births by Caesarean section still varies significantly in different countries and regions, in different hospitals, by the various factors such as social and economic health or individual factors, partly due to different perceptions of health workers and pregnant women about the benefits and risks of Caesarean section⁴. The increase has been observed to be among women of all ages and race. Many theories have been proffered to explain this trend, including a decrease in vaginal births after Cesarean delivery, decreased vaginal births of breech presentation, and increased prevalence of high risk pregnancies such as advanced maternal age and some subjective indications during labor such as non-reassuring fetal status and arrest of dilation⁵.  Although CS  is  a  safe operation,  when  performed  without  medical need but it put  mothers  and  their  babies  at  risk  of  short and long-term health  problems.  Most  complications  of  CS, however, come from the cause which leads to CS. Factors that make some women more likely to  have complications include: obesity, large infant size, prolonged labor, multiple  pregnancy, and  premature  labor.  In the absence of a clear medical indication, the excess risk associated with the operation itself must be considered. Short and long-term maternal and infant problems associated with elective caesarean section are higher than those associated with vaginal birth⁶.

 This study aimed to; determine CS rate during a decade, evaluate the first CS rate in comparison to second and over CS, and evaluate the main indications for a decision of CS.

Patients and methods

 This retrospective study was set to evaluate CS rate during a decade from the year 2010 to 2019 calculating the operation rate and the incidence rate of first CS in comparison to overall delivery rate in Al-Basrah Hospital for Maternity and Childhood. The information was collected from the statistical unit at the hospital. The main indications for a first operation, distribution of cases according to mother age and parity were calculated by review of the statistical records and the patient information registry of 700 operations during 2019.

 The total cesarean section rate is calculated as the number of births delivered by cesarean section divided by the total number of live births less the not-stated values for delivery method, multiplied by 100.

Results

 Table I, shows the incidence of CS during the study period 2010-2019. The rate has increased from 24.2% in 2010 to 38.5% in 2019 with an overall increasing rate over each year, noticing the increment in the total number of births and number of operations (14180 births, 3432 CS) in 2010 in comparison to (19138 births, 7384 CS) in 2019.

Table I: Incidence rate of CS in 2010-2019.

 Table II, shows the incidence of first CS during the years 2017, 2018 and 2019 in which the rate was nearly the same (47.8%, 46.4% and 50.2%) respectively.

Table II: The percentage of first CS to total CS.

 Table III, shows the incidence of first CS according to maternal age in which the highest rate was in the 18-29 age group (61%), followed by 30-39 group (26%).

Table III: Incidence of first CS according to age of mother in year 2019.

Table IV, describes the distribution of first CS according to parity of the mother in which the highest rate was in the prime mothers (485 cases), (69.2%) and decreasing with increasing parity of the mother.

Table IV: Number of first CS according to parity in year 2019.

 Table V, describes the main causes of first CS, failure to progress was the main cause (35%), infertility (20.4%), breech presentation (14.4%), meconium (8.2%), CPD (7%), high blood pressure (4%) followed by other causes.

Table V: Number of first CS according to the cause.