The Current Cesarean Section Rate and Factors Associated with it among Women Attending The Tertiary Care Hospital in Hazara Division

Abstract

The recent global upsurge in the trend of cesarean section rates presents a major health problem, especially for underdeveloped countries like Pakistan. The increasing cesarean section rate is a dilemma for the present world. This study, conducted at Ayub Teaching Hospital Abbottabad from June to November 2024, aims to analyze the C-section rate, assess contributing factors, and explore potential associations between these factors and their indications. This research seeks to provide valuable data and insights to the existing body of research on cesarean section rates and factors influencing delivery decisions. By sharing the findings, the study aims to foster a better understanding of C/S rates and promote improved practices in obstetric care in ATH and beyond.This cross-sectional study was conducted in the Department of Gynaecology at Ayub Teaching Hospital Abbottabad over a period of six months, from 1st June to 30th November 2024. It was based on a sample of 249 patients selected through a purposive non-probability sampling technique. Data were collected using a self-devised structured questionnaire. For data analysis, frequencies and percentages were calculated for categorical variables.The study reveals a 40.3% cesarean section rate, which is significantly higher than WHO recommendations, raising concerns about potential overuse and associated health risks. The most important and notable indication for cesarean section is “Previous CS” (26.9%), which shows a significant association with obstetrical hysterectomy, emphasizing the importance of previous C-section history. Malpresentation of the baby accounts for 6.0%, with associated risks in decision-making during childbirth. Placenta previa is another significant indication (2.4%), leading to a notable increase in emergency C-sections. “Fetal distress” (10.0%) and “Preeclampsia + PIH” (8.8%) also contribute to the C-section rate, with significant associations found between patient age and specific indications for C-section.“Elective C-section” is more common in cases of “Previous C-section” and “Malpresentation of the baby,” while “Emergency C-section” is more often associated with indications such as “Fetal distress,” “Preeclampsia + PIH,” “Obstructed labor,” and “Placenta previa and abruption.” Parity shows a strong association with cesarean indications, with multiparas having a higher frequency due to previous C-sections, while primiparas exhibit a higher occurrence related to breech presentation.The four main factors responsible for significant associations with cesarean indications were age (p = 0.019), family income (p = 0.043), type of cesarean section, and parity (p = 0.006). Positive trends are also observed in BMI, comorbidities, and lifestyle. “Previous CS” remains the major indication at 26.9%, while others include fetal distress, malpresentation, obstructed labour, etc. This study paves the way for further research to comprehensively understand and address the upsurge in C-section trends for improved maternal and neonatal health outcomes.