Generic placeholder image

Current Women`s Health Reviews


ISSN (Print): 1573-4048
ISSN (Online): 1875-6581

Research Article

Study on Maternal and Neonatal Outcome of Women Undergoing Caesarean Section using NICE Classification in a Tertiary Care Hospital in Rural Area of Central India - An Observational Prospective Study

Author(s): Shuchi M. Jain*, Ketki Thool, Manish A. Jain and Poonam V. Shivkumar

Volume 18, Issue 1, 2022

Published on: 08 February, 2021

Article ID: e061221191234 Pages: 8

DOI: 10.2174/1573404817666210208210008

Price: $65


Background: Caesarean section is often perceived to be safer than vaginal delivery for mothers and neonates and thus has become increasingly common around the globe. However, it may actually be detrimental to maternal and neonatal health while consuming valuable resources.

Objective: The objective of this study was to categorize the cesarean sections performed in our rural institute into various categories using NICE classification and to study the maternal and neonatal outcomes in them.

Methods: This was a prospective study of all women who underwent caesarean section over a period of 18 months. Data was retrieved from the files of women for morbidity and mortality in mothers and babies. Data was entered in MS Excel sheet and analyzed with percentages and chisquare test using SPSS ver.17.

Results: Caesarean section rate (CSR) was 36.88%. All CS were classified into four categories based on urgency as per NICE guidelines. There were 22.62% women in Category I, 38.61% in category II, 28.37% in category III and 10.40% in Category IV. Adhesions, an extension of angle, lacerations in the lower segment, scar dehiscence, atonic PPH and bladder injury were noted in (12.83%), 11.81%, 6.83%, 4.08%, 1.53% and 0.08% CS, respectively. Caesarean hysterectomy was done in 0.24% of cases. Postoperative morbidity was febrile morbidity (11.93%), post-dural puncture headache (13.85%), paralytic ileus (11.49%), wound infection (8.83%), ARDS (0.70%), sepsis (0.78%), pulmonary edema (0.47%) and pulmonary embolism (0.03%). Maternal mortality was 0.03%. Neonates born were 2577 (29 were twin deliveries). 82.46% of neonates were healthy, 16.80% had morbidities and 0.74% were stillborn. Apgar score of less than 7 was in 10% cases. 16.80% neonates were admitted to NICU during their hospital stay. Neonatal mortality was 1.47%.

Conclusion: Intraoperative and post-operative complications were more in cesarean sections of category I and II as compared to category III and category IV. Neonatal morbidity, mortality and admissions to NICU were more in cesarean sections of category I and II as compared to category III and category IV. Thus though the caesarean section is an emergency lifesaving procedure for mother and baby, it may prove detrimental to their health.

Keywords: Maternal, neonatal, morbidity, mortality, cesarean section, NICE classification.

Graphical Abstract
Gibbons L, Belizan JM, Lauer JA, Betran AP, Merialdi M, Althabe F. Inequities in the use of cesarean section deliveries in the world. Am J Obstet Gynecol 2012; 206(4): 331.e1-331.e19.
[] [PMID: 22464076]
Althabe F, Sosa C, Belizán JM, Gibbons L, Jacquerioz F, Bergel E. Cesarean section rates and maternal and neonatal mortality in low, medium, and high-income countries: An ecological study. Birth 2006; 33(4): 270-7.
[] [PMID: 17150064]
Betrán AP, Merialdi M, Lauer JA, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol 2007; 21(2): 98-113.
[] [PMID: 17302638]
Villar J, Carroli G, Zavaleta N, et al. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study. BMJ 2007; 335(7628): 1025.
[] [PMID: 17977819]
Ye J, Betrán AP, Guerrero Vela M, Souza JP, Zhang J. Searching for the optimal rate of medically necessary cesarean delivery. Birth 2014; 41(3): 237-44.
[] [PMID: 24720614]
Belizán JM, Althabe F, Cafferata ML. Health consequences of the increasing caesarean section rates. Epidemiology 2007; 18(4): 485-6.
[] [PMID: 17568221]
Gregory KD, Jackson S, Korst L, Fridman M. Cesarean versus vaginal delivery: Whose risks? Whose benefits? Am J Perinatol 2012; 29(1): 7-18.
[] [PMID: 21833896]
Eisenkop SM, Richman R, Platt LD, Paul RH. Urinary tract injury during cesarean section. Obstet Gynecol 1982; 60(5): 591-6.
[PMID: 7145252]
Hameed N, Ali MA. Maternal blood loss by expansion of uterine incision at caesarean section--a comparison between sharp and blunt techniques. J Ayub Med Coll Abbottabad 2004; 16(3): 47-50.
[PMID: 15631372]
Magann EF, Dodson MK, Ray MA, Harris RL, Martin JN Jr, Morrison JC. Preoperative skin preparation and intraoperative pelvic irrigation: impact on post-cesarean endometritis and wound infection. Obstet Gynecol 1993; 81(6): 922-5.
[PMID: 8497357]
Ramachandrappa A, Jain L. Elective cesarean section: Its impact on neonatal respiratory outcome. Clin Perinatol 2008; 35(2): 373-393, vii.
[] [PMID: 18456075]
Reuter S, Moser C, Baack M. Respiratory distress in the newborn. Pediatr Rev 2014; 35(10): 417-28.
[] [PMID: 25274969]
Soltanifar S, Russell R. The National Institute for Health and Clinical Excellence (NICE) guidelines for caesarean section, 2011 update: implications for the anaesthetist. Int J Obstet Anesth 2012; 21(3): 264-72.
[] [PMID: 22541846]
Tulandi T, Agdi M, Zarei A, Miner L, Sikirica V. Adhesion development and morbidity after repeat cesarean delivery. Am J Obstet Gynecol 2009; 201(1): 56.e1-6.
[] [PMID: 19576375]
Soltan MH, Al Nuaim L, Khashoggi T, Chowdhury N, Kangave D, Adelusi B. Sequelae of repeat cesarean sections. Int J Gynaecol Obstet 1996; 52(2): 127-32.
[] [PMID: 8855090]
Uygur D, Gun O, Kelekci S, Ozturk A, Ugur M, Mungan T. Multiple repeat caesarean section: is it safe? Eur J Obstet Gynecol Reprod Biol 2005; 119(2): 171-5.
[] [PMID: 15808374]
de la Torre L, González-Quintero VH, Mayor-Lynn K, et al. Significance of accidental extensions in the lower uterine segment during cesarean delivery. Am J Obstet Gynecol 2006; 194(5): e4-6.
[] [PMID: 16647896]
Bromley B, Pitcher BL, Klapholz H, Lichter E, Benacerraf BR. Sonographic appearance of uterine scar dehiscence. Int J Gynaecol Obstet 1995; 51(1): 53-6.
[] [PMID: 8582519]
Guise J-M, Hashima J, Osterweil P. Evidence-based vaginal birth after Caesarean section. Best Pract Res Clin Obstet Gynaecol 2005; 19(1): 117-30.
[] [PMID: 15749070]
Carroli G, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum haemorrhage: A systematic review. Best Pract Res Clin Obstet Gynaecol 2008; 22(6): 999-1012.
[] [PMID: 18819848]
Lagrew DC, Bush MC, McKeown AM, Lagrew NG. Emergent (crash) cesarean delivery: indications and outcomes. Am J Obstet Gynecol 2006; 194(6): 1638-43.
[] [PMID: 16731082]
Chanrachakul B, Chaturachinda K, Phuapradit W, Roungsipragarn R. Cesarean and postpartum hysterectomy. Int J Gynaecol Obstet 1996; 54(2): 109-13.
[] [PMID: 9236307]
Ali HM, Mohamed MY, Ahmed YM. Postdural puncture headache after spinal anesthesia in cesarean section: Experience in six months in 2736 patients in Kasr El Aini Teaching Hospital-Cairo University. Egypt J Anaesth 2014; 30(4): 383-6.
Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ 2007; 176(4): 455-60.
[] [PMID: 17296957]
Jakobi P, Weissman A, Sigler E, Margolis K, Zimmer EZ. Post-cesarean section febrile morbidity. Antibiotic prophylaxis in low-risk patients. J Reprod Med 1994; 39(9): 707-10.
[PMID: 7807484]
Pelle H, Jepsen OB, Larsen SO, et al. Wound infection after cesarean section. Infect Control 1986; 7(9): 456-61.
[] [PMID: 3639069]
Berhan Y, Abdela A. Emergency obstetric performance with emphasis on operative delivery outcome: Does it reflect the quality of care? Ethiop J Heal Dev 2004; 18(2): 96-106.
Moges A, Ademe B, Akessa G. Prevalence and outcome of caesarean section in Attat Hospital, Gurage Zone, SNNPR, Ethiopia. Arch Med 2015; 7(4): 8.
Benzouina S, Boubkraoui MM, Mrabet M, et al. Fetal outcome in emergency versus elective cesarean sections at Souissi Maternity Hospital, Rabat, Morocco. Pan Afr Med J 2016; 23(1): 197.
[] [PMID: 27347286]
De Luca R, Boulvain M, Irion O, Berner M, Pfister RE. Incidence of early neonatal mortality and morbidity after late-preterm and term cesarean delivery. Pediatrics 2009; 123(6): e1064-71.
[] [PMID: 19482739]
Dey N, Hatai SK. A study of caesarean section cases with special reference to maternal and neonatal outcome. J Indian Med Assoc 1992; 90(6): 149-51.
[PMID: 1522304]
Ghahiri A, Khosravi M. Maternal and neonatal morbidity and mortality rate in caesarean section and vaginal delivery. Adv Biomed Res 2015; 4: 193.
[PMID: 26605232]
Onankpa B, Ekele B. Fetal outcome following cesarean section in a university teaching hospital. J Natl Med Assoc 2009; 101(6): 578-81.
[] [PMID: 19585926]
Ali M, Ahmad M, Hafeez R. Maternal and fetal outcome. Prof Med J 2005; 12(01): 32-9.
Marshall NE, Fu R, Guise J-M. Impact of multiple cesarean deliveries on maternal morbidity: A systematic review. Am J Obstet Gynecol 2011; 205(3): 262.e1-8.
[] [PMID: 22071057]
Smith GCS, Pell JP, Dobbie R. Caesarean section and risk of unexplained stillbirth in subsequent pregnancy. Lancet 2003; 362(9398): 1779-84.
[] [PMID: 14654315]
Elvedi-Gasparović V, Klepac PT, Peter B. Maternal and fetal outcome in elective versus emergency caesarean section in a developing country. Coll Antropol 2006; 30(1): 113-8.
[PMID: 16617584]
Solheim KN, Esakoff TF, Little SE, Cheng YW, Sparks TN, Caughey AB. The effect of cesarean delivery rates on the future incidence of placenta previa, placenta accreta, and maternal mortality. J Matern Fetal Neonatal Med 2011; 24(11): 1341-6.
[] [PMID: 21381881]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy