O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2021 | ISSUE 3 | 13 Caesarean section indications and outcomes at a tertiary level hospital in South Africa FD Rubgega 1 , P Soma-Pillay 1 , P Becker 2 1 Department of Obstetrics and Gynaecology, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa 2 Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa Introduction In 1985, the World Health Organization (WHO) recommended a caesarean section (CS) rate of 10-15% for all births. 1 This recommendation followed the publication of two studies that found that CS rates higher than 10% at population level were not associated with reductions in maternal and neonatal mortality rates. The WHO also highlighted the need for CS and rather than focussing on achieving a specific rate, stated that very effort should be made to provide a CS to a woman who needs it. 1 A Caesarean section (CS) can be defined as the surgical ending of a pregnancy, or delivering a baby by opening of the uterus during an operation. 2 Over the past 30 years, caesarean section rates have increased well above the WHO recommendation. The International Federation of Gynaecology and Obstetrics (FIGO) analysed global CS rates in 2015. 3 This study analysed births in 169 countries (98.4% of the world’s births) and found that 29.7 million (21.1%) births occurred through CS. 3 This rate was much higher than the rate of 12.1% in 2000. The average annual rate of increase in CS use globally was 3.7% between 2000–2015. 3 A caesarean section does not only pose risk to the current pregnancy but also has implications for future pregnancies. Major short-term complications include haemorrhage that may require hysterectomy or transfusion, puerperal infection, wound disruption, wound haematoma, venous thromboembolism as well as anaesthetic risk. 4 Long-term risks of caesarean section include stillbirth, placenta accreta spectrum disorders, uterine rupture and scar pregnancy. 4 In an effort to curb rising caesarean sections rates, several studies have analysed indications for caesarean sections. 5 These include maternal, family and community, health professional factors Abstract Caesarean section rates have increased over the past 30 years and there has been lack of understanding of the drivers of these increased rates. The World Health Organisation has recommended the use of the Robson ten group classification as a system for assessing, monitoring, and comparing caesarean section rates at all levels. Aim The aim of this study was to determine the indications and caesarean section rate at a tertiary referral hospital. Methods This was a retrospective analysis of deliveries between 1 January 2014 and 31 December 2018 at a tertiary level hospital in Pretoria, South Africa. The Robson’s 10 group classification was used in classifying the caesarean sections. Results A total of 15 295 deliveries took place during the study period: 6 883 women delivered vaginally (NVD) and 8 412 women by caesarean sections (CS). The average CS rate was 55%. Robson’s 10 Group 5 (all multiparous, ≥1 previous CS, ≥ 37 weeks, single cephalic pregnancy) was the greatest contributor to the CS rate (29%). Most women who delivered were between the ages 20-35yrs (n= 12000, 78.6%), with majority delivering via CS deliveries (n=6616, 55.1%) compared to NVDs (n=5388, 44.9%). The CS rate for women with underlying medical disease was 19% and women with hypertensive disorders of pregnancy were the largest contributor to this group (n=1241, 14.8%). The caesarean section rate for women classified as a maternal near miss was 69.6%. There was no statistically significant difference in the rate of postpartum haemorrhage between women who delivered vaginally NVD (n=173) compared to those who delivered by CS (n=245) p=0.132). Conclusion Strategies to reduce the primary caesarean deliveries and steps to improve VBAC success rates should be considered and implemented. In a tertiary hospital, Robson’s 10 group classification alone does not give a full description of the caesarean section rate; other causes like medical conditions need to be considered. Health care workers should follow local guidelines to reduce the risk of complications related to hypertensive disorders in pregnancy. Correspondence Francoise Dudu Rubgega email: rubgee91@gmail.com O&G Forum 2021; 31: 13 - 16 ORIGINAL RESEARCH