Evaluation of Cesarean Sections done at Ain Shams University Maternity hospital From 2007 to 2011

Abstract

Cesarean sections are one of the most commonly performed surgical operations worldwide. Though evidence suggests that non-medically indicated cesarean sections raise the health risks for mothers and their babies and result in increased costs of health care compared with vaginal deliveries, reports are common that the frequency of performance of this surgical procedure is far above WHO recommendations. We explored aspects that relate to the practice of cesarean section that might shed light on determining why cesarean section rate is increasing, how we could reduce that increasing rate and to what extent cesarean operation is considered. The study was conducted in Ain Shams university maternity hospital. Records of women who underwent cesarean sections at the emergency department during the five years from 2007 to 2011 were retrospectively reviewed. Which takes into account characteristics such as age, parity, period of gestation, labor status, indication of cesarean delivery, procedures applied, comorbidities, complications and mortality. The incidence of cesarean section in Ain Shams University maternity hospital is markedly increased over the time period from 1997 (21.86%) to 2007 (38.15%) to 2011 (39.98%). The study revealed that the most common indications of cesarean section are repeat cesarean, dystocia, nonreassuring fetal condition and breech presentation. Repeat cesarean is the major indication; unfortunately the primary cesarean decision is not always in the hand of a responsible practitioner. So efforts to decrease the primary cesarean rate should include different institutions. In addition, VBAC can be an important component of programs to reduce cesarean delivery rates in patients with term singleton fetuses with vertex presentations. Most women who have had one previous cesarean delivery with a low-transverse incision are candidates for VBAC. Aiming at reduction of the primary cesarean rate The incidence of dysfunctional labor or dystocia could be decreased by four methods: (1) provision of labor support; (2) avoidance of hospital admission in latent stage of labor; (3) avoidance of elective induction with an unripe cervix; and (4) cautious use of epidural analgesia. Physicians need to consider four issues when caring for women with dystocia: (1) if the contractions are adequate; (2) if there is fetal malposition; (3) if there is cephalopelvic disproportion caused by suspected macrosomia or a contracted pelvis; and (4) if there are - other coexisting clinical issues (e.g., chorioamnionitis, nonreassuring fetal monitoring) that will impact the treatment options.