Changing Prevalence of Cesarean Section, Repeated Cesarean Section and Indications for Repeated Cesarean Section Over 10 year Period at a Tertiary Care Center, Karachi

Objective: To study the change in frequency of cesarean section, repeat cesarean section and the indications for repeated cesarean section after 10 years at a tertiary care center in Karachi. Methods: This study was conducted in the department of Obstetrics and Gynaecology, unit 1, Abbasi Shaheed Hospital. This retrospective analysis used departmental records to compare cesarean section rates for 2 years, 10 years apart. i.e. 2002 and 2012.The study thus spans a twelve month period extending from 1st January 2002 to 31st December 2002 and twelve months from 1st January 2012 to 31st December 2012.Using data from both study periods women who had successful vaginal birth after cesarean and women who had a repeat cesarean section were determined. Additionally, the rate of repeat cesarean section and indications for repeat cesarean section were analyzed for each study period. Results: In year 2002, 411 out of 1425 total births had cesarean. The cesarean section rate was 28.8%, whereas in 2012, the cesarean section rate was 44% (615 out of 1212 total births). Ninety-two out of 411(22.38%) in 2002 had prior cesarean section, whereas 192 out of 615 (44%) had prior cesarean section in 2012. In those with previous cesarean section, successful vaginal birth after Cesarean section was 38% in 2002 and 21.88% in 2012. The leading indications for repeat cesarean were non-progress of labour, fetal distress and scar tenderness. Maternal wish contributed to 4.6% repeat cesareans in 2012, whereas only 1.7% of study population desired repeat cesarean section in 2002. Conclusion: Cesarean rates are on the rise in this tertiary care center of Karachi. As compared to ten years back, the rate has risen from 28.8% to 44%. The overall high section rate at this center may be accounted for by the fact that it deals with high risk Obstetrics and referred cases from Karachi and the province of Sindh. However, 16% rise in overall cesarean is quite dramatic.