Prevalence and characteristics of caesarean section (CS) among pregnant women who delivered at the Colonial War Memorial Hospital (CWMH) Suva, Fiji, 2016

Abstract

IntroductionIn recent decades we have noted a marked increase in caesarean section (CS) rates in both developed anddeveloping countries. Institutional data indicate a rise in CS rates in Fiji however published data in thisregard is lacking. This study aims to estimate the prevalence and identify the characteristics of CS atColonial War Memorial Hospital (CWMH) in 2016.MethodologyThis is a retrospective audit of 1625 women who underwent CS at CWMH from 1st January 2016 to 31stDecember 2016. A data collection form was developed to collect data from the birth register book. Thedata collected included patients’ demographic characteristics, indication for CS, surgeon hierarchy, andwound check review. Data was analyzed using SPS and the results were presented in tables and graphs.ResultsOf the1625 CS patients who met the study criteria, the majority were I-Taukei (77%; n=1148) and 20-34years old (60%; n=887) and Primigravida (45.5%, n=739). Caesarean delivery was mostly performed bysenior registrar (n=1002; 62%). Of 1625 CS 87.7% (n=1409) were emergency CS and 13.3% (n=216) wereelective CS. Fetal distress was found in 56% (n=911) of all CS cases. , followed by obstructed labour(15.6%) and foetus mal-presentation (13%). More than half of patients (n=537; 59.0%) were considered asnon-reassuring for fetal distress. In obstructed labour group 81.1% (n=223) were first stage obstruction.Breech was most common mal-presentation (n=192; 86%). The results of the study revealed that there wasa high compliance rate (n=1435; 97%) of non-private CS mothers (n 1478) followed at CWMH for awound check following caesarean.ConclusionIn 2016 CWMH recorded it highest rate of CS births and while it just at the newly defineoptimum CS rate, it is part of a rising trend in CS rates in CWMH. In this respect there is aconcern that the majority of CS was done on first time mothers with at least secondary leveleducation, this trend as this would suggest an ongoing trend to increasing CS rates. There is aneed to define fetal distress and arrested labour amongst these women to reduce unnecessary CS.Further studies are needed to explore the impact of this CS rate on hospital budget and resourcesand therefore the implications of a rising trend.