Obstetrical correlates of the first time cesarean section, compared with the repeated cesarean section

To determine the clinical and epidemiological characteristics in patients having their first cesarean section (FCS) and compare it with findings in patients with repeated cesarean section (RCS).

A cross-sectional, comparative study.

Unit 'A' of the Department of Obstetrics and Gynaecology, Postgraduate Medical Institute of Lady Reading Hospital, Peshawar, Pakistan, from January to December 2005.

This study included all the women who gave birth by cesarean sections, 817 of the total 5992 deliveries, at this unit during the study period. Data on potential risk factors for the first cesarean section (FCS) and repeated cesarean section (RCS) were extracted from medical records, which were reviewed and compared between these two groups of women. Data were statistically analyzed with student t-test for comparison between means and Chi-square test for comparison between percentages. Crude odds ratio (OR) with 95% confidence interval (95% CI) were calculated. Significance was taken at p < 0.05.

The incidence of cesarean sections was 13.62% of the total deliveries, with the FCS frequency of 70.13 % (573) and RCS frequency of 29.87% (244). The three most frequent indications for FCS were dystocia and cephalopelvic disproportion (42.8%), fetal distress (18.5%), and abnormal presentation (32.1%). Meanwhile, those for RCS were previous cesarean section (41%), dystocia (27.5%) and abnormal presentation (15.2%). The factors significantly associated with FCS were: age < 20 years, first pregnancy, premature rupture of membranes, antecedent of labor room induction and neonatal weight above 3500 g (p < 0.05). More cases of emergency cesarean sections, antipartum hemorrhage, malpresentations and traditional birth attendants (TBA's) handling were encountered in the FCS group (p < 0.05). Percentages of second gravidity and multigravidity were greater in RCS patients. Fetal outcome was also good in the RCS group. No difference between the groups was found regarding educational level and prenatal consultations (p > 0.05).

The frequency of first cesarean section and repeat cesarean section is high in our setup. Adequate following of the programs to diminish the percentage of FCS by curtailing its predisposing factors is needed.