Analysis of high caesarean section rates: the second step after audits using the Ten Group Classification System

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Public Health

Background:

• High caesarean section rates pose significant public health challenges globally.
• Tertiary care hospitals often experience elevated rates due to complex cases.
• Identifying specific contributing factors is crucial for targeted interventions.

Purpose of the Study:

• To identify methods for reducing high caesarean section rates in a tertiary care hospital.
• To analyze factors contributing to caesarean sections using a modified Robson’s classification.

Main Methods:

• Analysis of birth weight, maternal age, and caesarean section indications.
• Utilized a modified Robson’s 10 Group Classification of caesarean section (TGCS).
• Data collected from 2010-2014 at a tertiary care hospital in Sri Lanka.

Main Results:

• Nulliparous (NTSV) and multiparous (MTSV) women with neonates weighing 2500-2999g comprised significant portions of caesarean sections.
• Indications included fetal distress, subfertility, advanced maternal age, and cephalopelvic disproportion.
• Women over 35 years had a higher risk of caesarean section, regardless of parity or previous caesarean history.

Conclusions:

• Consider reducing caesarean section rates in NTSV, MTSV, and women with one previous caesarean section, particularly those with fetuses weighing 2500-2999g.
• Advanced maternal age and subfertility alone should not be routine indications for caesarean section.
• Improvement in the diagnosis of fetal distress is recommended, and caesarean sections for vaginal varices and cephalopelvic disproportion should be avoided.