An audit of increasing cesarean section rate in primigravidas

Aim: to determine the rate of cesarean sections in primigravida and to identify the various determinants and factors for these cesarean sections. study design: prospective study. place and duration of study: government lady aitchison hospital,king edward medical university lahore from jan 2013 to dec 2013. methods: two hundred and fifty patients at term were enrolled and clinical record was maintained. it included all the pregnant women at term,booked in the antenatal clinic and the unbooked patients admitted in early labour for which cesarean sections were indicated later. detailed history was taken and examination was carried out. a clinical record was maintained which included,antenatal booking status,gestational age,labour pains,leaking per vaginum,bleeding,blood pressure,indications and complications of cesarean sections and neonatal outcome. results: total 250 patients were included in the study. (49.2%) patients had antenatal record with them while (50.8%) patients presented through emergency without antenatal checkup. induction of labour was carried out in (18.4%) patients due to various indications. in (46.8%) patients,the labour either did not start or progressed only for less than 5 hours and prolonged for more than 10 hours in (21.2%) cases. (45.6%) patients had leaking of amniotic fluids. hypertention was seen in (16.4%) patients. in (79.6%) patients,fetal presentation was cephalic and (20.4%) had different malpresentations of which the breech was the commonest; (74.5%). ctg was reactive in (48%) cases while nonreactive in (26.4%). amniotic fluid was adequate in (62.4%) cases and scanty in (36.8%) cases. the most common indication of cesaraean section was fetal distress in (60.80%) and maplresentions in (20.4%) cases. in unbooked primigravidas,the complications seen were fetal distress (60.5%),malpresentations (52.9%),hypertension (46.3%).