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Research Article

The rising trend in caesarean section rates: should we and can we reduce it?

Authors:

Malik Goonewardene ,

Academic Department of Obstetrics and Gynaecology, Teaching Hospital, Mahamodara, Galle, LK
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DMA Kumara,

Academic Department of Obstetrics and Gynaecology, Teaching Hospital, Mahamodara, Galle, LK
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DR Jathun Arachchi,

Academic Department of Obstetrics and Gynaecology, Teaching Hospital, Mahamodara, Galle, LK
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R Vithanage,

Unit B, Teaching Hospital, Mahamodara, Galle, LK
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R Wijeweera

Unit A, Teaching Hospital, Mahamodara, Galle, LK
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Abstract

Introduction: The rising caesarean section ( CS) rates in Sri Lanka are causing great concern.

Objective: To study whether it would be justified and feasible to attempt reducing the rising caesarean section (CS) rates at the Teaching Hospital, Mahamodara, Galle (THMG).

Method: Using the records available at the THMG, the trends in CS rates from 2007-2010 were studied. A prospective audit of CS was carried out in 2010, using a modified version of Robson’s Ten Group Classification of Caesarean Sections.

Results: During 2007-2010 the mean CS rate in THMG has significantly increased, and fluctuated between 29.6% and 33.5 %, with no significant changes in perinatal morbidity and mortality, but with a significant increase in the proportion of mothers requiring intensive monitoring and intensive care. In 2010 the CS rates in THMG varied from 44.2% in Unit A, to 31.8% in the Academic Unit and 23.6% in Unit B. The main contributions to the high CS rates in the three units of the THMG were from the categories 5A and 5B (repeat CS), 2B (nulliparous term singleton vertex-NTSV, prior to the onset of labour), 1 (NTSV in spontaneous labour) and 2A (NTSV after induction of labour). The proportions in these categories varied significantly from one unit to another.

Conclusions: A detailed analysis of the indications for CS in each group in each of the units is required. The possibility of more nulliparous women and women with only one previous CS scar and no other obstetric complication being carefully selected for a trial of vaginal birth should be explored. The possibility of pre-induction cervical ripening and careful selection of NTSV for induction of labour, and improving intrapartum management and the specificity of diagnosis of antepartum and intrapartum fetal distress needs to be explored. Reducing the high CS rates appears to be justified and feasible in THMG.

DOI: http://dx.doi.org/10.4038/sljog.v34i1.4816

Sri Lanka Journal of Obstetrics and Gynaecology 2012; 34: 11-18

Keywords: CS Caesarean section 
DOI: http://doi.org/10.4038/sljog.v34i1.4816
How to Cite: Goonewardene, M. et al., (2012). The rising trend in caesarean section rates: should we and can we reduce it?. Sri Lanka Journal of Obstetrics and Gynaecology. 34(1), pp.11–18. DOI: http://doi.org/10.4038/sljog.v34i1.4816
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Published on 25 Oct 2012.
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