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Caesarean delivery defines the birth of a fetus via laparotomy and then hysterotomy. Caesarean section rates have continued to increase worldwide in recent years. The reasons for increase in the caesarean delivery rates may be due to increase in number of elderly primi gravidae, caesarean delivery on maternal request, fear of litigation in obstetric practice and the reluctance on the part of obstetricians and the patients to accept even minute errors and many more. Rise in caesarean section rate should be assessed for improving quality of care for the pregnant woman. We evaluated the rate of caesarean births according to Robson criteria in our birth centre and aimed to determine the cause of this rising trend and assess the efficacy of various measures taken to reduce the rate of caesarean section. Methods:The study was conducted in a Command Hospital of the Armed Forces which is a tertiary care centre. Data of the patients who delivered between January 2014 to December 2016 were collected from labour room register and those women who delivered by caesarean section were classified according to Robson’s classification. As strict measures were instituted to reduce the rates as per the ACOG Obstetric care consensus at the beginning of the year 2016 we undertook to assess the efficacy of those measures in comparison to the previous two years. The rates were calculated for all the three years according to the various groups as per Robson’s classification. Results:Total number of deliveries in 2014, 2015 and 2016 were 984, 973 and 980 respectively, out of which the annual caesarean rate in 2014 was 30.38% , 2015 was 30.6% and 2016 was 28.57% and the average rate in last three years was 29.86%. The caesarean rate was higher than stipulated WHO 15%. The percentage of patients falling into Robson-2 was 20.46%, 16.11% and 11.07% in the year 2014, 2015 and 2016 respectively which showed a significant reduction. The percentage of patients falling into Robson-4 showed significant reduction in the rate of caesarean section in multiparous women who had previous vaginal delivery (4.01%, 3.36% and 0.36% respectively). The major percentage of caesarean section rates was in Robson-5 group, 57.68%, 64.43% and 72.50% for the three years respectively. Regarding the Robson-8 group we determined that there was an increase in vaginal delivery for twin pregnancy. Robson-10, showed decreasing trend with complete reduction of preterm delivery (4.68%, 1.34% and 0.0% respectively) which was statistically significant. Our study has found that there was a fall in the caesarean section rate in the year 2016 as compared to the preceding 2 years. Conclusion: Various measures were taken to reduce the primary caesareans as per the ACOG Obstetric care consensus. The caesarean rate in 2014 was 30.38% , 2015 was 30.62% and 2016 was 28.57% and the reduction in primary caesarean rate contributed significantly to the decrease in overall caesarean rate by 2.05 % in 2016.

iosr journal of dental and medical sciences

To Assess the Efficacy of the Measures Taken to Reduce the Primary Caesarean Rates and Its Impact on Overall Caesarean Rate in a Tertiary Care Hospital