An evaluation of the indications for caesarean sections at Chris Hani Baragwanath Academic Hospital
Background. A systematic review concluded that a caesarean section (CS) performed for medical indications will save lives; however, it is associated with short- and long-term complications. The CS rate at Chris Hani Baragwanath Academic Hospital (CHBAH) was 39.78% in 2015.
Objectives. To evaluate the indications for CSs at CHBAH.
Methods. This was a cross-sectional study conducted on the data collected in the week of 23 June to 29 June 2015. Each file was evaluated for the correctness of the decision by at least two researchers. Each reviewer could state that he/she absolutely agreed, partially agreed, did not agree or could not make an assessment.
Results. The mean (standard deviation (SD)) age of the women was 27.01 (6.35) (range 15 - 44) years. The median (interquartile range (IQR)) parity was 1 (0 - 2) (range 0 - 4). No co-morbidities were found in 13.6% (n=20) of the reviewed cases. Complications were found to have occurred in 17% (n=25) of women who gave birth over the week reviewed. The median (IQR) gestational age at delivery was 38.14 (36.39 - 40.14) (range 28.0 - 42.4) weeks. The median (IQR) Apgar (5 minutes) was 10 (9 - 10) (range 0 - 10). The median (IQR) birth weight was 3 040 (2 530 - 3 440) (range 825 - 4 575) g. The most common indications were fetal distress (n=73; 49.66%) and dystocia (n=42; 28.57%). There was absolute agreement between the two reviewers in the following: retained second twin, antepartum haemorrhage (APH) of unknown origin, placenta previa, severe intrauterine growth restriction, multiple pregnancy, abnormal presentation, eclampsia and two previous CSs. When the indication was fetal distress, dystocia, second-stage CS, or one previous CS, the absolute agreement was between 73.85% and 90.24%.
Conclusion. There were few absolute disagreements with the indication cited. Methods used to diagnose fetal distress and dystocia must be evaluated.