Authors:

Abstract

Objective To identify possible methods of reducing high caesarean section rates in the University Obstetric Unit, Teaching Hospital Mahamodara, Sri Lanka.

Methods Analysis of birth weight of neonates, maternal age and indications for caesarean section in the groups identified by a modification of Robson’s 10 Group Classification of caesarean section (TGCS), which contribute significantly  to the high caesarean section rates in the  University Obstetric Unit, Teaching Hospital Mahamodara, Galle Sri Lanka during  2010 - to 2014.

Results Among nulliparous women, at term, having a singleton fetus, with a vertex presentation (NTSV) who underwent a caesarian section 25.6% delivered neonates weighing between 2500g and 2999g. Among multiparous women, at term, with no previous caesarean section, having a singleton fetus with a vertex presentation (MTSV) who underwent a caesarian section, those delivering  neonates weighing between 2500g and 2999g ranged from 25.6% to 34.6%. Indications for ante partum caesarean section included fetal distress, subfertility, increased maternal age and cephalo-pelvic disproportion in NTSV, and fetal distress, vaginal varices, and a bad obstetric history in MTSV. Among multiparous women with one previous caesarean section undergoing repeat caesarean section, 29.8% delivered neonates weighing between 2500g and 2999g. Women >35 years had a higher risk of caesarean section, irrespective of whether they were nulliparous or multiparous, and whether they had a previous caesarean section or not.

Conclusion A reduction in caesarean section rates in NTSV and MTSV, and women with one previous caesarean section, especially in those with fetuses weighing 2500g - 2999g, should be considered. Increased maternal age and subfertility per se should not be routine indications for antepartum caesarean section. Antepartum caesarean section for vaginal varices and cephalo-pelvic disproportion should be avoided. The diagnosis of fetal distress should be improved. 

Keywords: Modified Robson’s TGCS, Caesarean Section rates, Sri Lanka