Trends of caesarean sections for failure to progress: Indian rural experience

Summary

The present observational study was carried out at a rural referral healthcare, educational institute in India. The objectives were to study the trends of contribution of caesarean section (CS) for failure-to-progress to the overall CS rate and their relationship to variables such as age, parity, stage of labour, augmentation of labour, in order to look at the trends and the scope for reduction in the CS for failure-to-progress and also the reduction in fetomaternal morbidity either by early intervention or reducing CS rates. Over 16 years, a total of 7,309 caesarean operations were performed, (contributing to 22.5% of births) and 533 (7.3%) were for failure-to-progress. The rate of CS for failure-to-progress was reduced in 2002 (5.0%), compared with 1992 (10.5%). The age of these women were similar to overall cases. A majority (346, 64.9%) of Sections for failure-to-progress were performed between 37 and 40 weeks of pregnancy, 125 (23.5%) between 41 and 42 weeks and only 62 (11.6%) were preterm. Rates of CS for failure-to-progress were 16.3% in primigravida and 8.8% in multipara, a decade ago, compared with 7.0% in primigravida and 2.8% in multipara now. Among the primigravida, 66 (18.3%) were performed in latent phase, 217 (60.3%) in the active first stage and 77 (21.4%) in the second stage of labour. Among multigravida, 35 (20.2%) were in the latent phase, 68 (39.3%) in the active first stage and 70 (40.5%) in the second stage. The authors were not always involved in the decisions to proceed to CS but probably because of the discussions before the observational study was undertaken, everyone involved with the decision making became concerned. So it seems critical evaluation of each CS before decision (keeping in mind materno-fetal well-being rather than hours), separating imminent labour from latent phase and higher doses of oxytocin should lead to a reduction in CS for failure-to-progress. Efforts need to be continued and should involve further research and evidence-based management strategies.