Indications for Cesarean Sections in Rural Nepal

Area of Science:

• Obstetrics and Gynecology
• Global Health
• Maternal Health

Background:

• Global cesarean section (CS) rates approach 26%, with significant disparities between urban and rural areas in Nepal (15% vs. 3.5%).
• Understanding CS rates and indications in remote, rural settings is crucial for assessing maternal care needs.

Purpose of the Study:

• To determine the cesarean section (CS) rate at a remote hospital in rural Nepal.
• To identify the primary indications for CS in this specific population.

Main Methods:

• A one-year prospective cross-sectional study conducted from August 2014 to August 2015 at Okhaldhunga Community Hospital (OCH).
• Semi-structured interviews were performed with 91 women who underwent CS, with translation assistance as needed.
• The study also noted the utilization of a connected maternal waiting home.

Main Results:

• The hospital's CS rate was 9.5% (91 out of 864 births).
• Leading indications for CS were prolonged labor (26.4%), abnormal fetal lie (25.3%), and fetal distress (19.8%).
• Approximately 75% of CS procedures were emergencies, and nearly half of the women utilized the maternal waiting home pre-delivery.

Conclusions:

• The CS rate at Okhaldhunga Community Hospital is relatively low and within World Health Organization (WHO) guidelines.
• Indications for CS were consistent with those observed in other countries, and no evidence of overuse was found.
• Maternal request was not identified as the sole indication for any CS performed during the study period.