Incidence And Factors Associated With Caesarean Section In Primigravida Women: A Retrospective Cohort Study

Abstract

Aim: Current study was conducted to determine the incidence and factors associated with caesarean sections in primigravida.
Methods: This retrospective study was conducted in the Department of Obstetrics and Gynaecology at a tertiary care govt hospital from June 2021 to May 2022. A total of 2345 primigravida patients visited the hospital for delivery. Out of these, 361 underwent Caesarean Section (CS) deliveries after 28 weeks of gestation. This study focused specifically on the 361 primigravida patients who underwent either emergency or elective primary CS. Clinical data of the patients were collected from the medical records.
Results: Total number of primigravida CS were 361 (15.39%) of which emergency CS accounted for 92.0% (332 cases). Majority (79.2%) of the patients were between 21 and 30 years old. The analysis of body mass index (BMI) and period of gestation (POG) in relation to the type of CS revealed no statistically significant difference. Non-progress of labor (NPOL) was commonest indication of CS at 24.1% (87 cases) followed by Foetal distress 21,7% (78 cases), malpresentation15.8% (57 cases) and failed induction at 13.3% (48 cases). Significant obstetric risk factors in our study were GDM, hypothyroidism and obesity. GDM was more common in our population (24.3%). The analysis showed no significant association of GDM, Hypertension, Hypothyroidism , Covid 19 infection, IUGR, Thick MSL and Twin pregnancy with emergency LSCS. Anaemia, PPROM and Preeclampsia showed a high propensity for Emergency LSCS (Large OR). Breech presentation and post-IVF pregnancies were found to be significantly associated with elective LSCS, while other obstetric risk factors did not show statistically significant associations.
Conclusion: Caesarean sections are absolutely critical and can be lifesaving in certain situations where vaginal deliveries would pose hazard and reduce both maternal and neonatal mortality and morbidity, so health care infrastructure should must ensure timely access to those who need them. Contrarily, needless caesarean sections run the risk of endangering the lives and health of expectant mothers and their children. As majority of these (92℅ of these) were only performed as part of emergency protocol, it reflects that if strict clinical and ethical guidelines are adhered to, the rate of caesarean section could be well controlled and optimal.
Improving prenatal screening programs, educating patients on healthy lifestyle as well the benefits and low risk factors for normal vaginal delivery can reduce the rising caesarean section rates and in turn enhance the maternal and neonatal outcomes as well as alleviate the financial burden on healthcare system.