An evaluation of the indications for caesarean sections at Chris Hani Baragwanath Academic Hospital

Background:A systematic review concluded that a caesarean section that is performed for medical indications will save lives, but is associated with short and long term complications. The caesarean section rate at CHBAH was 39.78% in 2015. Objectives:To evaluate the indications for caesarean section.Methods:This was a cross-sectional study in the week 23rd June to the 29th 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 assessmen.Results:The mean age was 27.01 (6.35; range- 15-44). The median parity was 1(IQR=0-2; range=0-4). No co-morbdities was found in 20 (13.61%). Complications occurred in 25 (17.01%) women. The median gestational age at delivery was 38.14 (IQR=36.39-40.14; range-28.0-42.4). The median Apgar (5 min) was 10 (IQR=9-10; range- 0-10). The median birth weight was 3040 g (IQR=2530-3440; range- 825-4575 g). The most common indications were fetal distress (n=73; 49.66%) and dystocia (n=42; 28.57%). There was absolute agreement between the 2 reviewers in the following; retained 2nd twin, APH of unknown origin, placenta previa, severe IUGR, multiple pregnancy, abnormal presentation, eclampsia, two caesarean sections. When the indication was fetal distress, dystocia, 2nd stage caesarean section, or with 1 previous caesarean the absolute agreement was between 73.85% and 90.24%.Conclusion:There were few absolute disagreements with the indication. There needs to be an evaluation of methods to diagnose fetal distress and dystocia. Â