Cesarean section deliveries in Fiji, 1986 to 1996

Cesarean section rates and outcomes in Fiji have not been previously reported in the literature. Between 1986 and 1996, Fiji's cesarean section rates rose 2.5%, from 9.4% to 11.9%. Labor dystocia (33%), repeat cesarean (18%), and "fetal distress" (17%) were the most common indications for performing c-sections. A retrospective case-control study covering the period 1986-1996 in Fiji's three referral hospitals found that cesarean deliveries were three times more likely to involve child mortality (O.R. = 3.01, 95% c.l. = 1.19 < OR < 8.08), 26 times more likely to involve maternal morbidity (O.R. = 26.53, 95% c.l. = 8.10 < OR < 105.38), and 13 times more likely to require blood transfusion (OR = 13.17, 95% c.l. = 7.09 < OR < 25.05). Cesarean deliveries also required an average of 6 days spent in the hospital, compared to two days for vaginal deliveries. Children delivered by cesarean in the study population were 6 times more likely to have a 5-minute Apgar score below 7 and 4 times more likely to have an Apgar score below 5. Fourteen percent (14%) of cesareans followed an attempted induction of labor, while 1 in 11 women delivering vaginally underwent an attempted induction of labor for "Social reasons". The study found scope to potentially reduce the number of first and repeat cesareans through active labor monitoring, development of uniform clinical guidelines and indications for cesarean intervention and labor induction, and increased trial of labor for women with a history of a previous cesarean.