LMC journal Vol. 2.indd 108 Journal of Lumbini Medical College Indica ons of caesarean sec on- Study of 200 Cases in Lumbini Medical College Shrestha BK Department of Obstretics and Gynaecology, Lumbini Medical College Teaching Hospital, Palpa, Nepal Corresponding author: Dr. Buddhi Kumar Shrestha, Lecturer, Department of Obstretics and Gynaecology, Lumbini Medical College Teaching Hospital, Palpa, Nepal; e-mailvictor_522004@hotmail.com ABSTRACT Background: A Caesarean sec on is a surgical procedure in which one or more incisions are made through a mother's abdomen (laparotomy) and uterus to deliver one or more babies, or, rarely, to remove a dead fetus. Methods and Materials: This study was a prospec ve descrip ve one. It was done in Lumbini Medical College from 2068 Shrawan to 2069 Ashad. A total of 1419 deliveries occurred of which 234 deliveries by LSCS, incidence of LSCS was 16%. The commonest age group being operated ranged from 21-25 years (47.5%). Most of the pa ents who had undergone LSCS were mul gravida-50.5%. The sec on was due to various indica ons, the most commonest cause in this study were fetal distress and obstructed labour, non progress of labour, the primary rate of LSCS was 85% while repeat sec on being 15%. Results: The Peak range of opera ons were done. In pa ents with 5 feet 2 inches height, the rate of elec ve LSCS 26.5%. Where emergency CS were done in 73.5% of cases. Regarding fetel outcome 97.5% survived and 2.5% had death. Conclusions : Fetal distress and non progress of labor was the commonest indica on for Caesarean sec on in our ins tui on. Keyword: Caesarean sec on,incisions, indica ons INTRODUCTION Caesarean sec on is a common opera ve procedure in obstetrics prac ce. Though it was introduced in clinical prac ce as a lifesaving procedure both for mother and newborn. The rising trend of caesarian section in modern obstetrics is a major concern in health care system all over the world.1 According to WHO rates of LSCS in many countries have increased beyond the recommended level of 15%, specially in France, Australia, North America, UK, Brazil, China and India the rate of LSCS in America 23% ll 1991. The na onal C sec on rate of Canada was 20% and Italy was 17.5%.1 Even though the indica on of CS have not changed so far and these remain foetal distress, malpresenta on, mul ple gesta on, previous caesarean, protracted labour and CS on demand, Current available data from developed countries revealed morbidity and mortality from CS is more than in vaginal delivery for both the mother and fetus. Thus this study was conducted to evaluate the rate and indica on for CS in various indica on. METHOD OF STUDY This prospec ve study was carried out in the department of obstetrics and gynecology, Lumbini Medical College, Palpa from 2068 Asadh to 2069 Shrwan. Total 200 cases were selected after taking consent, detailed history was taken from all cases, examina on was done from date of admission up to the day of discharge. 34 cases were excluded because of improper ANC records which was done outside. CPD was tested mainly by clinically pelvimetry labor patient was monitored by doing Partogram. In elective cases-all investigation done. Puerperal period up to the day of discharge was observed. 90% of pa ent operated by spinal anesthesia, 10% under GA. Blood Donor was kept ready in selected cases such as Placenta Preavia, repeat LSCS and Eclampsia. RESULT A total of 1419 deliveries occurred the study period of which 1185 deliveries were by Vaginally and 234 delivery by LSCS. The rate of LSCS among all these delivery 16%. Indica on of Caeserian-sec on- study of 200 cases in Lumbini Medical College, Palpa. DISCUSSION Caesarean sec on is used in cases in which vaginal delivery either is not feasible or would impose undue risk on mother or baby. Due to greater awareness of serious fetal distress & avoidance of mid forceps & vaginal breech deliveries the rate of LSCS has steadily increased from (5% to 20%).2 In this study the total number of deliveries was 1419 and of which 234 (16%) was caesarean deliveries. The incidence of LSCS only 16% in our study which was nearing the WHO recommenda on. Analysis of age of the pa ent showed that 72.5% of cases (table 1) were in the age group of maximum fer lity i.e. between 20- 30yrs. A study in IPGMR showed 89% amongst this age group.3 The study of La n American hospital showed Original Article L M Coll J 2013; 1(2): 108-110 109 BK Shrestha maximum incidence >30 years in primi pa ents, which might refl ect delayed marriage in (western countries).4 Table-1: Age of Pa ent who underwent LSCS (N=200) Age Groups (years) Percentage 15-20 20% 21-25 47.5% 26-30 25% 31-35 5% 36-40 25% Total 100% This table shows LSCS % maximum at age 21-25yrs. Short maternal height has been associated with an increased of CPD, in our study (table 2) showed that 68% patent were more than 5 feet. Alam showed 76% pa ent >5' and Zaman showed 70% >5' in their studies.5,6 This may be explained by the fact that all the LSCS were not only due to CPD. Table-2: Incidence of LSCS in rela on to height of the pa ent (N=200) Height (feet) Percentage 40 2% 408" 4% 4.90-5" 26% 5.1" 28% 5.2" 25% 5.3" 12% Above 5.4" 3% Total 100% From the above table, 68% patent were above 5 feet in height-32% were below 5 feet Study in IPGMR 1987, Sir Sallimullah Medical College (SSMC) & Mi ord Hospital 1992 showed higher incidence in mul .4-6 Present study also correlates with it (Fig. I). In the developed countries in the past decade indica ons of LSCS were breech presenta on, fetal distress, previous sec on & dystocia.7 In this study, common indica ons were fetal distress 22%, NOPL 16.5%, previous LSCS 12.5%, obstructed labor 10%, pre-eclampsia and eclampsia 9.5%, breech 8%, bad obstetric history 5%. Table-3: Indica on for LSCS (N=200) Indica on Total Prime Mul Previous LSCS 30 0 30 Foetal distress 44 26 18 Obstructed labour 20 15 5 NPOL (induc on failed) 33 23 10 Pre-eclampsia 15 9 6 Bad obstetric history 10 - 10 Breech Px 16 8 8 CPD 13 7 6 Transverse lie 3 2 1 Placenta praevia 2 2 0 Eclampsia 4 3 1 Cord prolapse 4 1 3 Face presenta on 3 2 1 Brow presenta on 3 1 2 This table shows fetal distress and NPOL(non progress of labor). Mainly responsible for LSCS in Primigravida. Previous CS was main indication in multigravidia among all, fetal distress occupiese the highest indication of LSCS Table-4: Nature of opera ons with indica on (N=200) Indica on Nature of Elec ve (%) Emergency (%) Previous CS 12.5% 2.5% Foetal disetres 0 22% Obstructed labour 0 10% NPOL 0 16.5% Pre-eclampsia 1% 6.5% Eclampsia 0 2% Bad obstetric history 5% 0 Breech presenta on 5% 3% Placenta Pravia 1% 0 CPD 2% 4.5% Corel prolapse 0 2% face presenta on 0 1.5% Brow presenta on 0 1.5% Transverse lie 0 1.5% Total 26.5% 73.5% The table shows emergency LSCS was 73.5% and elective LSCS was 26.5%. Table-5: Comparison of Primary and Repeat Sec on (N=200) Caeserean sec on Percentage Primary 85% Repeat 12% Third sec on 3% This section show primary section was more relation to repeat section. Repeat sec ons cons tute the commonest indica on for LSCS in most other countries. It varies from 35% of all LSCS in the USA to 23% in Norway, the lowest 18% being in Hungry.8But in our college in 200 cases lowest repeat sec on 15%. In a study in IPGMR elective LSCS was 52% and 110 Journal of Lumbini Medical College emergency LSCS was 48%.6 This was because pa ents due to previous opera on or pregnancy associated complica ons, admi ed in that ins tute for elec ve LSCS. There are high incidence of elective LSCS in western countries because of their sophisticated electronic foetal monitoring system.9 Diff erent studies from India showed incidence of emergency sec on was 82.7% and 85.92%.10 Study in SSMC & Mi ord Hospital fi ndings of emergency LSCS was 69.71% and elec ve LSCS was 30.29%.4 This correlates with our study, where emergency LSCS was 73.5% and elec ve was 26.5%. This may be explained by the fact that the pa ents were brought into hospital when crises arise, when tradi onal birth a endants may have failed to deliver them with utmost a empt. In a study by Dawn and Chakrabar at Eden Hospital, Kolkata, the incidence of morbidity was 37.5% and abdominal wound infec on was major morbidity.11 Hammouda reported a maternal morbidity rate of 28.5% in the form of wound and urinary tract infec on & there were no maternal death.12 Present experience was similar to this study. CONCLUSION In modern obstetrics, Caesarean sec on is a major surgical procedure for delivery. In spite of its low rate of maternal morbidity and mortality due to improved surgical technique and modern anesthetic skill, it s ll carries a slightly greater risk than normal vaginal delivery and more risk in subsequent pregnancies. Those risks can be reduced by giving advice for a strict and regular antenatal check up during pregnancies to emphasize the need for an elec ve opera on, if the indica ons are recurrent one. 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