Original article / research
Determinants and Outcomes of Primary Caesarean Section: A Retrospective Observational Study
QC06-QC09
Correspondence
C Kavyarani,
4th Cross, Jayanagara, Kolar-563101, Karnataka, India.
E-mail:kavyaranic@gmail.com
Introduction: A Primary Caesarean Section (PCS) is defined as the first caesarean delivery in a woman with no previous uterine scar. PCS rates are rising globally, necessitating an understanding of associated factors to improve maternal and foetal outcomes.
Aim: To determine the prevalence of PCS, examine its indications, and analyse sociodemographic and obstetric factors associated with PCS, with particular emphasis on parity.
Materials and Methods: The present retrospective observational study was carried out between March 2024 and December 2024 in the Department of Obstetrics and Gynaecology at Sri Devaraj Urs Medical College, Kolar, Karnataka, India. A total of 620 women undergoing PCS with a gestational age of >28 weeks were enrolled. Data on maternal age, Body Mass Index (BMI), parity, gestational age, antenatal co-morbidities, and indications for caesarean section were collected from medical records. Chi-square and binary logistic regression analyses identified significant associations and independent predictors of PCS.
Results: Out of 2710 deliveries, 872 were PCS (32% overall rate). Among 620 included participants, 330 were predominantly under 25 years (53.2%), 394 were from lower socioeconomic status (63.5%), and 450 were primigravida (72.6%). The leading indication was foetal distress among 220 participants, accounting for 35.5% of cases, followed by cephalopelvic disproportion in 98 participants (15.8%). Fifty PCS were due to maternal request and accounted for 8.1%. Factors significantly associated with higher odds of PCS included maternal age ≥36 years (Adjusted Odds Ratio (AOR) 5.16; 95% Confidence Interval (CI): 2.39-11.26), although the wide confidence interval suggests limited precision due to the smaller number of women in this age category. PCS was also associated with increased maternal morbidity (AOR 4.19) and neonatal intensive care unit admission (AOR 2.20). Notably, all neonatal deaths occurred among multigravid mothers.
Conclusion: PCS remains a major contributor to rising caesarean rates. Factors such as advanced maternal age, high BMI, diabetes mellitus, and induction of labour significantly increase the likelihood of PCS. Targeted strategies, including adherence to evidence-based guidelines, judicious labour management, and regular audits, are essential to reduce unnecessary PCSs while ensuring maternal and neonatal safety.