Determinants of primary vs previous caesarean delivery in a tertiary care institution in Kerala, India

Abstract

Introduction: Caesarean delivery is one of the most performed surgical procedures and is a globally recognised maternal health-care indicator.Aim: To study the determinants of primary and previous caesareans in a tertiary care teaching hospital in Kerala.Methodology: A observational study was conducted over a period of 12 months from 1st January 2018 to 31st December 2018 to analyse the maternal and foetal determinants of primary and previous caesarean deliveries. Data was collected and analysed.Results: Maternal age was a significant predictor of primary caesarean. Employed mothers constituted 40% previous caesareans (p value 0.001). There were more obstetric referrals undergoing primary caesareans (p value-0.003) than repeat caesareans. 30% primary caesareans belonged to lower (p value-0.001) in contrast to 14 % in previous caesareans. Primary Caesareans underwent emergency decisions significantly (p value-0.001) while previous caesareans were decided as elective procedures. 34.59% babies born via primary caesareans were of low-birth weight (p value-0.001). Extended hospital stay (>8 days) was evidenced in 38.12% of first -time caesareans (p value-0.001). NICU stay pattern was similar in both the groups.Conclusion: Good clinical policies regarding induction of labour and labour analgesia must be routinely implemented in all health care institutions to reduce the primary caesarean delivery which can indirectly reduce abnormally invasive placentation (AIP) and morbidities in subsequent pregnancies.