PATTERNS AND DETERMINANTS OF CESAREAN SECTION INDICATIONS

Abstract

Cesarean section (CS) is a lifesaving obstetric procedure when appropriately indicated, yet its rapidly rising use worldwide has raised concern about avoidable surgery and its short- and long-term consequences. Understanding local patterns of CS indications is essential for designing strategies to optimize its use.

To describe the frequency and distribution of major indications for CS and to examine their association with maternal age, parity, socioeconomic status, and gestational age in a tertiary-care setting.

This cross-sectional study included 100 women undergoing caesarean delivery at a district tertiary hospital. Demographic and obstetric data were collected using a structured proforma. Indications assessed were repeat CS, fetal distress, oligohydramnios, post-date pregnancy, and prolonged labor. Stratified analyses by age, parity, socioeconomic status, and gestational age were performed, and associations were tested using the chi-square test.

Repeat CS was the leading indication (29%), followed by oligohydramnios (23%), post-date pregnancy (19%), and prolonged labor (18%); fetal distress accounted for 11% of cases. Parity showed a significant relationship with fetal distress, which was more than three times higher among women with parity ≥4 compared to those with parity 1–3. Gestational age significantly influenced prolonged labor and oligohydramnios, both peaking in late-term and post-term pregnancies, whereas maternal age and socioeconomic status were not significantly associated with any CS indication.

Conclusion: Previous cesarean, advanced gestation, and higher parity are the key drivers of CS in this population. Strengthening counselling for VBAC, close surveillance of late-term pregnancies, and rational decision-making for high-parity women may help curb unnecessary cesarean deliveries.

Key Words:

Caesarean section, indications, repeat CS, oligohydramnios, prolonged labor, fetal distress, parity, gestational age, maternal outcomes.