FACTORS ASSOCIATED WITH INCREASED

INCIDENCE OF CAESAREAN SECTION DELIVERIES

AT SGTH, SWAT

4th YEAR MBBS

BATCH-E

Professor Doctor Naeem-Ullah Supervisor: DR. Samina Rehmat

Head Of Community Medicine Department Demonstrator Community Medicine

Department

Saidu Medical College, Swat Saidu Medical College, Swat

TABLE OF CONTENTS

1. Approval certificate

2. Supervisor certificate

3. Acknowledgment

4. Introduction

5. Literature review

6. Questionnaire

7. Methods

8. Results

9. Discussion

10.Conclusion

11.References
 DEPARTMENT OF COMMUNITY MEDICINE

SAIDU MEDICAL COLLEGE SWAT

CERTIFICATE APPROVAL

It is stated that students of 4th year MBBS Saidu Medical College Swat session 2022 are hereby

given an approval by department of Community Medicine Saidu Medical College Swat to do

research on topic “Factors associated with increased incidence of c-section at SGTH, SWAT”

under the supervision of Prof. Dr. Naeem Ullah.

Prof. Dr. Naeem Ullah

Head of department community medicine

Saidu Medical College, Swat.

Dated .
 DEPARTMENT OF COMMUNITY MEDICINE

SAIDU MEDICAL COLLEGE SWAT

SUPERVISOR’S CERTIFICATE

This is to certify that Fourth year MBBS has worked under my supervision for the project

“FACTORS RESPONSIBLE FOR INCREASED INCIDENCE OF CAESAREAN SECTION

DELIVERIES AT SGTH, SWAT”

I have checked the project and approved their efforts.

Supervisor: DR. Samina Rehmat

Demonstrator Community Medicine Department

Saidu Medical College, Swat

Dated .
ACKNOWLEDGEMENT

All praises and glory to Allah almighty, the most beneficent and merciful, for bestowing us the

power and ability to complete this research project.

We are extremely grateful towards Professor DR. Naeem-Ullah, Head of community medicine

department and our project supervisor, Dr. Samina Rehmat for their guidance and support in

this project. Our supervisor helped and guided us in every aspect regarding the completion of this

task. It goes without saying that we owe a lot to our teachers who educated us not only regarding

our fields of choice but also life in general. I would also like to acknowledge the hard work and

efforts of every single member of our batch, and the time they spent on data collection,

compilation, checking, and re checking every aspect of this project. It was a true team effort, and

we are extremely satisfied with what we have achieved over the past few weeks.

4TH YEAR MBBS

BATCH-E

YEAR 2022-23
 PARTICIPANTS

1.USMAN AMEEN (592) 2. IFTEKHAR AHMAD (593)

3. ZEESHAN AHMAD (563) 4. M. IMRAN (594)

5. ADNAN IQBAL (564) 6. M.DAOOD KHAN (596)

7. M. SOHAIL (565) 8. TARIQ SALAM (597)

9. MUNEEB AHMAD (567) 10. AZHAR MEHMOOD (599)

11. FAWAD ALI (569) 12. KAMRAN KHAN (600)

13. OSAMA MUNIR (570) 14. MARINA KHAN (522)

15. ABDUL QUDOOS (591) 16. REHANA SALEEM (543)

17. USMAN ALI (562) 18. NADIA KHAN (548)

19. AZMAT ALAM (566) 20. SAJIDA KHAN (554)

21. LAL MUHAMMAD (598)

 CHAPTER 1

INTRODUCTION

Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by

which one or more babies are delivered through an incision in the mother's abdomen, often

performed because vaginal delivery would put the baby or mother at risk. Reasons for the

operation include obstructed labor, twin pregnancies, maternal hypertension, breech births, and

issues with the placenta or umbilical cord are a few causes necessitating the surgery. Depending

on the mother's pelvic shape or past C-section history, a caesarean delivery may be carried out. A

trial vaginal delivery following a C-section may be feasible. The World Health Organization

advises against performing caesarean sections unless absolutely essential. The majority of C-

sections are carried out at someone's request, typically the mother, without a medical

justification.

According to research that was published in JAMA, doctors suggest that for the greatest level of

safety, 19% of deliveries should be by cesarian section.

The most frequent method and notion used in the past to determine optimum caesarean rates is

determined by the number of deliveries that take place in a hospital. The World Health

Organization (WHO) proposed a 15% caesarean section upper limit rate as the maximum

acceptable level. Based on the caesarean rates of the nations with the lowest rates of maternal

and newborn death at the time of the recommendation, both developed and developing nations

were considered. Since that time, the World Health Organization has stated that acceptable

caesarean section rates should fall between 5 and 15%.

The average caesarean section rate was found to be 27% in four South East Asian nations

participating in the SEA-ORCHID (South East Asia - Optimising Reproductive and Child Health

in Developing countries) program.

In Pakistan, one in every five newborns is born via caesarean section (C-Section). According to

the most recent Pakistan Demographic and Health Survey (PDHS) data, the percentage of

deliveries performed via C-section has increased significantly from 14% in 2012–13 to 22% in

2017–18. According to the World Health Organization's statement, C-section rates higher than

10% are not linked to a decrease in maternal or newborn death (WHO, 2015). The World Health

Organization's recommended rates are being exceeded, indicating that Pakistan is following a

global trend of women having C-sections for non-medical reasons.

Why are high C-Section rates a cause for concern? There are four main explanations. First, many

C-sections may raise the likelihood of adverse effects on the physical and mental health of both

the mother and the child. According to a review of 79 research that compared the results of C-

Section deliveries to those of regular deliveries, C-Section deliveries are thought to carry a

substantial risk of subsequent medical issues.

The overall fertility rate in Pakistan is 3.6 births per woman, which means that we continue to

have high fertility. Following the C-Section study, a normal delivery becomes dangerous because

there are no medical records for prior births available. The likelihood of a future C-Section

increases for mothers who have had previous ones. We are unnecessarily subjecting women to

major surgery repeatedly because of the high number of C-Sections in the nation.

Third, Pakistan lacks a plethora of resources. Patients seeking public health care occasionally

cannot obtain standard antibiotics from hospital pharmacies. Health policymakers, managers, and

practitioners should have serious concerns about using resources on a surgical treatment for non-

medical reasons. Fourth, high rates of C-sections in any nation could be caused by one of two

things: either the maternal health care industry is increasing the rates for financial benefit, or it is

being done medically unnecessarily on women's requests.

Numerous causes have allegedly contributed to the global rise in caesarean sections. While

several studies noted that breech presentation, multiple pregnancies, fetal discomfort, premature

rupture of the amniotic fluid membrane (PROM), cephalic pelvic disproportion (CPD), and fetal

distress were all linked to an increased rate of caesarean sections. Others have shown that it is

connected to maternal preferences and the location of health seeking (private vs. public). A few

more studies also supported the association between mother age and caesarean section. Birth

weight, parity, maternal height, and previous antenatal care visits (ANC) are all characteristics

linked to caesarean sections, according to several other research as well. APH (antepartum

haemorrhage), multiple pregnancies, cord prolapse, mothers' HIV infection status, and prior

caesarean section history were also identified as contributing variables to an elevated caesarean

section rate.
On the mother's request, it has been demonstrated that a sizable proportion of obstetricians would

consent to perform an elective CS without an obstetrical indication. There is currently a great

deal of discussion on whether this surgical treatment should be carried out on women who do not

clearly have clinically acceptable indications.

This study aimed to evaluate the occurrence and contributing factors of caesarean sections at

SGTH, SAIDU SHARIF SWAT.

 CHAPTER 2

LITRATURE REVIEW

The life-saving obstetric operation known as a Caesarean section (C-section) lowers

maternal mortality and enhances reproductive health. Although vaginal birth is still a vitally safe

and affordable route of delivery, C-sections are occasionally performed when they aren't even

necessary, which poses health risks for both expectant mothers and their newborn babies.

According to epidemiological studies, C-sections have become more common during the

previous ten years in every country in the world. According to the most current Pakistan

demographic and health survey conducted in 2017–2018, 22% of deliveries in Pakistan are

through C-section. This study adds to the body of knowledge by analyzing the factors affecting

Pakistan's high C-section rates.

The World Health Organization (WHO) states that the caesarean section (C-section)

should only be performed in clinical practice under certain circumstances, when the mother's or

the newborn's life is in danger, and that its use should not be increased above 10% or decreased

below 5%.

A narrative assessment of works on "factors influencing C-section rates in Pakistan" that

were published between 2000 and 2020 was conducted. The results highlighted five factors that
significantly affect the use of C-sections. These are: 1. Accessibility to C-sections; 2. Association

of C-section rates with socioeconomic profile; 3. Elective C-section; 4. Medical conditions as a

cause of C-section; and 5. C-section as a source of revenue. Like other Low Middle Income

Countries (LMICs), Pakistan's weak and frail health system is being burdened by an increase in

sickness. The overuse of C-sections has put additional strain on Pakistan's healthcare system and

raised the need for financial and medical resources for mother care.

Numerous studies have discovered that a variety of institutional, demographic, and

socioeconomic factors influence the chance of a C-section birth. The prevalence of C-sections is

correlated with the accessibility of facilities, obstetricians, and the place of birth, i.e., private or

public sector institutions. Multiple conception, mother age at birth, the rise in institutional births,

the number of prior deliveries, the location of prenatal care (private or public), the

socioeconomic condition of the household, and access to antenatal care are all strongly linked to

C-sections. The chance of C-section is also substantially correlated with other maternal traits,

including education and availability to prenatal care

In Pakistan, one in every five newborns is born via caesarean section (C-Section).

According to the most recent Pakistan Demographic and Health Survey (PDHS) data, the

percentage of deliveries performed via C-section has increased significantly from 14% in 2012–

13 to 22% in 2017–18. Is Pakistan's C-Section rate too high? The answer would unquestionably

be yes. According to the World Health Organization's statement, C-section rates higher than 10%

are not linked to a decrease in maternal or newborn death (WHO, 2015). The World Health

Organization's recommended rates are being exceeded, indicating that Pakistan is following a

global trend of women having C-sections for non-medical reasons. Why are high C-Section rates

a cause for concern? There are four main explanations. First, many C-sections may raise the
likelihood of adverse effects on the physical and mental health of both the mother and the child.

C-section deliveries are thought to carry a greater risk of developing future medical issues,

according to an analysis of 79 research comparing the results of these procedures to those of

regular deliveries (Jose et al., 2007). The overall fertility rate in Pakistan is 3.6 births per woman,

which means that we continue to have high fertility. Following the C-Section study, a normal

delivery becomes dangerous because there are no medical records for prior births available. The

likelihood of a future C-Section increases for mothers who have had previous ones. We are

unnecessarily subjecting women to major surgery repeatedly because of the high number of C-

Sections in the nation. Third, Pakistan lacks abundant natural resources. Patients seeking public

health care occasionally cannot obtain standard antibiotics from hospital pharmacies. Health

policymakers, managers, and practitioners should have serious concerns about using resources

on a surgical treatment for non-medical reasons.

The goal of a 75% reduction in maternal fatalities by 2015 has not been met by many

developing nations, including Pakistan, despite international efforts to promote maternal health.

Reducing the prevalence of maternal mortality requires addressing socioeconomic disparities in

access to emergency obstetric care. This study was conducted to look at socioeconomic

disparities and time trends in the use of caesarean sections (C-sections) in Pakistan from 1990 to

2013. We made use of information from the 1990 to 2013 Pakistan Demographic and Health

Surveys (PDHS). With a sample size of 6611, 10,023, and 13,558 women in 1990–1991–2006–

2007–2012–2013, respectively, and an overall response rate of above 90%, all of these surveys

are conducted nationally among ever–married women between the ages of 15 and 49. Women

who had their most recent live delivery in the five years prior to the surveys served as the study's

analytical unit. According to a few selected sociodemographic traits of women, bivariate analysis
and multivariable logistic regression models were used to assess the occurrence of caesarean

sections. The prevalence of C-sections was found to have increased over this time, with an

especially notable increase from 2.7% in 1990–1991 to 15.8% in 2012–2013, with lower

utilization among uneducated women (7.5%) compared to those with higher education (40.3%).

The percentage of C-sections ranged from 5.5% for the poorest mothers to 35.3% for the richest.

In contrast to the 25.6% of metropolitan women who underwent a C-section, only 11.5% of rural

women did. Richest, most educated, and urban-dwelling women were found to be more likely to

undergo a caesarean section, but there was no discernible difference in caesarean section rates

between the private and public sectors in any of the three surveys. To address the underuse of C-

sections in poor and rural areas and overuse in rich and urban areas, routine monitoring and

assessment of the provision of emergency obstetric care are required.

In the past 20 years, the number of deliveries by caesarean section has risen atypically in

a number of nations, including Pakistan. The current study's objectives are to assess the

caesarean delivery trend among Pakistani childbearing women (aged 15 to 49) and to determine

the maternal sociodemographic characteristics and pregnancy-related variables that have

changed during the course of the study, from 1990 to 2018. Methods Analysis was done using

secondary data from the Pakistan Demographic and Health Surveys from 1990 to 2018. The data

analysis was limited to mothers who were currently carrying children. Sample sizes for the years

1990–1991–2006–2007–2012–2017–2018 were 4,029, 5,721, 7,461, and 8,287, respectively.

Mothers' sociodemographic data and factors relating to pregnancy were used as independent

variables in the current study. Unadjusted odds ratios (OR) and adjusted odds ratios were used to

quantify the relationship between the independent variables and caesarean deliveries (AOR).

Results The percentage of moms who had caesarean births among those who had at least one
birth in the five years before each survey climbed steadily, rising from 3.2% in 1990–1991 to

19.6% in 2017–18. According to the findings, moms over 24 who lived in metropolitan areas,

were from Punjab, belonged to the richest socioeconomic class, and were located there were

more likely to have given birth via caesarean section. Mothers who had five or more children,

had their firstborn in the birth order, had more antenatal care visits, and gave birth in private

hospitals had a higher likelihood of having a caesarean section. Conclusions The results of this

study support the gradual increase in the number of mothers in Pakistan who have had caesarean

sections over the previous 20 years. In light of this, health departments ought to take some action

to limit the number of caesarean deliveries. A few key actions that can aid in minimizing

unnecessary caesarean deliveries in Pakistan include raising awareness among women about

pregnancy problems and providing gynecologists with detailed information on the medically

indicated causes of caesarean delivery.

Obstetrical factors including prolonged labor, breech or aberrant fetal presentation, large

size of the baby, unsettling heart rate of the baby, older mother, and history of previous

caesarean delivery. Placenta previa, placental abruption, placenta accreta, prolapsed cord,

maternal age, diabetes, obesity, hypertension, gestational diabetes, pre-eclampsia, eclampsia, and

mother preference are additional factors that could call for CS. Maternal requests because of

psychological, sociocultural, and institutional reasons, healthcare system or institutional factors,

increased accessibility to institutional births, comfort of the doctor's financial incentives or

commercialization of the birth process, and doctors' fear of legal action are some of the factors

causing increased use of CS.

The South Asian Association for Regional Cooperation is known by its acronym,

SAARC. It was formed in 1985 in Dhaka, the capital of Bangladesh, with the signing of the
SAARC Charter. The main objectives of the founding of SAARC included, among many other

things, advancing the welfare of the populations of South Asian nations by enhancing their

standard of living, economic progress, and sociocultural advancement. The average CS birth rate

in Southeast Asia was 14.8% (1.7%-32.0%), with an over 11% absolute rise rate between 1990

and 2014, according to Betrán et al. 18.6% was the global average, and between 1990 and 2014,

there was an overall increase rate of 12.4%.

In India, it was determined through analysis of the data from the "district level household

survey-4" conducted in 2011 across 19 states that 22,111 live births occurred. Of these, CS

carried out deliveries in the public and private sectors, respectively, at a rate of 13.7% and

37.9%. CS rates in India grew fourfold between 1992 and 2006, according to data from the

WHO (2.40% and 8.37%, respectively). In India, Verma et al. reported a rate that was about 14%

overall (24% in urban and 11% in rural population). In another assessment, the entire country's

CS rate was 33.8% for the Maldives, 8.5% for Pakistan, 9.8% for India, and 5.2% for Nepal.

16.1% of all CS in India occurred in public spaces, while 29.7% did so in private settings.

Maldives has CS rates in public and private institutions of 34.0% and 40.1%, Pakistan has rates

of 22.0% and 23.4%, while Nepal has rates of 9.4% and 21.6%. The Verma et al. analysis

showed that these countries have recently experienced growing rates. Only Nepal had a CS rate

that was lower than the Benova L (2017) report's average, which was 12.15 % in Pakistan and

31.7 % in the Maldives. According to urban and rural environments, CS rates vary. By analyzing

Nepal's five years of National Demographic and Health Survey data (1996-2016), Bhandari,

Dhungel, and Rahman discovered rising rates for both the population base and institution-based

CS rates. In India, Bangladesh, and Pakistan, the CS rates were substantially higher among the
wealthy quintile of the population, with Bangladesh topping 15%, according to a WHO report.

CS births also occur in SAARC nations.

The trend of C-sections is steadily rising globally, especially in recent decades. There are

many factors contributing to the rise in C-sections, including maternal, fetal, and financial

factors.

Similarly, the rate of C-sections has increased in Pakistan over the past few decades, which has

many risk factors and effects on the area's socioeconomic position.

 QUESTAINNAIRE

Name: Husband name:

Age:

Residence: urban\rural

Education:

Primary

High school

College and above

1. What was the nature of your c-section?

Emergency\elective

2. This c-section was done because of?

Mal-presentation of the baby

Post dated

Utero-vaginal prolapse
3. Do you have any history of medical diseases?

Diabetes

Hypertension

Cardiovascular diseases

Anemia

Obesity

4. Do you have any past surgical history of;

Previous c-section

AP repair

Laparotomy

Herniorrhaphy

5. How many ante-natal visits you have taken during this pregnancy?

One

Two

Three

Nil
6. Had you done any ultrasound by obstetric specialist during this pregnancy

Yes/No

7. Did you have any carcinomatous condition?

Cervical carcinoma

Endometrial carcinoma

Fibroids

8. Is it your first c-section?

Yes/No

9. How many number of pregnancies you have?

One

Two

Three

More than three

10. Was this c section done because of;

Maternal wish

BTL

Planned
 11. What was the weight of baby at the time of birth?

2kg

3kg

5kg

Above 5kg

12. What were the number of babies born alive or dead?

13. Do you have any past history of vaginal tear?

Vaginal tear

Cervical tear

Third degree tear

Fourth degree tear

14. Have you experienced any bleeding during third trimester?

Yes\No

15. If yes, then the characteristics of bleeding.

Color
 Amount

Painful

Painless

16. Did you have any episode of fits during pregnancy?

Yes\No

17. Did you have any abnormal swelling of the body along with high blood pressure during

pregnancy?

Yes\No

18. What were the number of babies delivered during this pregnancy?

Single

Twins

Triple

Quadruple

19. What was the duration of labor?

4 hours

8 hours
 12 hours

More than 12 hours

20. Did you have any ultrasound investigations done by your doctor?

Oligohydramnios

Polyhydramnios

Cord around neck

21. What was the color of the liquor at the time of delivery or birth?

Clear

Green or yellowish

22. Did you experience any mishap during labor?

Cord prolapse

Shoulder dystocia

Bowel prolapse
 CHAPTER 3

METHODS

The study is a descriptive cross-sectional analysis of eligible patient records that included 25

mothers who had undergone cesarean delivery from 15 September to 5 October 2022.The

exclusion and inclusion criteria for the recruitment of participants under study are given below.

Informed consent was obtained from all the participants at the beginning of the survey.

STUDY DESIGN:

Descriptive study cross-sectional survey.

POPULATION:

Only females with c-section deliveries at SGTH, SWAT.

LOCATION:

Saidu Sharif, Swat, KPK Pakistan

CLINICAL SETTING:

GYNAE AND OBS. WARD AT SGTH, SWAT

Our study included those females who had their c-section done at SGTH, SWAT. Our study

included questions about demographics such as (age, residence), maternal, fetal and

socioeconomic factors responsible for increased rate of c-section deliveries.

CHAPTER 4

Results

A sample of 25 patients was included in the study. Inclusion criteria was all female patients with

c-section delivery admitted to SGTH, SWAT. Mean age of our sample for study is 32.4 years. In

our study 16 out of 25 (64%) had emergency c-section while 9 out of 25 (36%) had elective c

section. 60% of the patients with c-section delivery were found to be 30 years old or above. The

following figure shows comparison between emergency and elective c-section deliveries.

70

60

50

40

comparison
30

20

10

0
Emergency Elective
 FIGURE: 1

We find that c-section delivery is more common in patients belonging to urban areas (i.e 64%) as

compared to those patients belonging to rural areas (i.e 36 %) as shown in the figure:1

70

60

50

40
C-section related to residency
30

20

10

0
Urban Rural

FIGURE:2

In our study we find that there is increased incidence of c-section amount the patients who had

previous history of medical disease like hypertension, diabetes, cardiovascular diseases, anemia

or obesity. 18 out of 25 patients (72%) had a previous history of medical diseases and the

association of different medical diseases with increased incidence of c-section is shown in figure.
 45
40
35
30
25
20
15
10
5
0
Hypertension Diabetes Anemia Obesity

Association of medical diseases with increased incidence of c-section.

FIGURE: 3

We also find that there is increased incidence of c-section among the patients who had previous

c-section, 15 out of 25 (60%) as compared to those who had not any history of previous c-

section.
 36
Previous c-section history
No history of s-section
64

We also find that among the factors associated with emergency c-section, mal-presentation of the

baby at the time of delivery was more common. 64% of the patients had malpresentation of the

baby while other factors which were less common are also shown in a diagrammatic presentation

in the following figure.

12

24 Malpresentaion of baby
post dated
utero-vaginal prolapse
64

There is also a connection of increased c-section deliveries with ant-e-natal visits. Those patients

who had three or more ant-e-natal visits were investigated properly for ultrasound abnormalities
and abnormalities were found earlier that helped them making their decision about planned c-

section delivery. The following graph shows that 16 out of 25 patients who opted for elective

c-section had abnormal ultrasound findings during their ant-e-natal visits. Among the abnormal

ultrasound findings cord around the neck was found to be more common.

40

35

30

25

20
Ultrasound abnormalities
15

10

0
Oligohydramnios Polyhydramnios Cord around neck

Ante-natal visits

36
three or more visits
less than three visits

64
Our study reveals a persistent upsurge of caesarean deliveries for mothers with more than three

antenatal care visits or more.

According to our study, small size or low birth weight of the infant are not closely linked to the

need for a caesarean delivery because mothers who were informed of these factors at the time of

delivery had a lower likelihood of having one

CHAPTER 5

DISCUSSION

According to new research by WHO, there is continuous rise of c-section deliveries all over the

globe. Worldwide, the percentage of births that occur via caesarean section has increased to more

than 1 in 5 (21%) births. According to the study, this number is expected to rise over the next ten

years, with nearly a third (29%) of all newborns expected to be delivered via caesarean section
by 2030. In our study we evaluated the association of different factors that are responsible for

increased incidence of caesarean section.

Twenty-two factors associated with caesarean section measured in this study contain (1)

demographical aspects :(age, residence and education status.); (2) maternal aspects: (medical

disease such as hypertension, diabetes, anemia, obesity, carcinoma, history of previous c-section,

previous surgeries, vaginal tear ante-natal visits, multiple pregnancies); (3) fetal aspects:

(malpresentation of the baby, cord around the neck, abnormal ultrasound abnormalities, shoulder

dystocia);(4) socioeconomic factors. In this study we found that the factors that are commonly

associated with increased incidence of c-section are age (i.e 35 or above), medical diseases,

abnormal ultrasound findings, urban residency, abnormal fetal presentations, previous history of

c-section and multiple pregnancies.

Our research shows that mothers who have had more than four prenatal care visits experience a

consistent increase in caesarean deliveries. Although there is no obvious explanation for this, it

might be believed that gynaecologists requested frequent antenatal care visits from women who

had pregnancy issues including obesity, hypertension, or diabetes in order to manage

unfavourable obstetric risks.

According to the most recent Pakistan Demographic and Health Survey (PDHS) data, the

percentage of deliveries performed via C-section has increased significantly from 14% in 2012–

13 to 22% in 2017–18. According to the World Health Organization's statement, C-section rates

higher than 10% are not linked to a decrease in maternal or newborn death (WHO, 2015). The

World Health Organization's recommended rates are being exceeded, indicating that Pakistan is

following a global trend of women having C-sections for non-medical reasons. This increased

incidence is of concern mainly for three reasons. First, it causes negative impacts on maternal
and fetal mental health. Second, there is still high fertility with no proper records. This is of

concern because a mother who had previous c-section delivery is duly exposed to the caesarian

section again. Third, we are a poor country with scarce resources. That means there is risk of

spending extra amount on surgical procedures for non-medical reasons.

Despite the fact that it has been acknowledged that caesarean sections may contribute to a

decrease in the mother and child death rate, risks associated with caesarean surgery must not be

overlooked. A current study shows that the frequency of caesarean deliveries has been rising

over time in our hospitals and clinics and it can be attributed to the lack of knowledge that this

method is safer and reliable than normal vaginal delivery.

Strength of study:

Strength of study is data collected specifically from admitted patients and excluded all other data

like opd and general population records. In order to minimize the bias, the random sampling

technique was applied instead of convenience sampling.

Limitations of study:

There are a number of limitations in this study. The sample size was small. Thus, this is a

hospital-based study and it only included the data of mothers who had their c-section delivery

done at SGTH, SWAT. This study only refers to the possibility of the risk factors that can be

associated with increased incidence of c-section. This is a limited study. As far as the data is

concerned, it cannot be projected over the whole population.

 CHAPTER 6

CONCLUSION

It is concluded in this study that there is high frequency of patients admitted for C-section

delivery in SGTH Swat. Those patients whose age is 35 or above with multiple pregnancies, or

those with a previous history of c-section are at greater risk for the C-section delivery. Also, the

patients with history of medical diseases such as hypertension, diabetes, obesity and anemia are

also at higher risk for the c-section delivery. Our study also showed that mothers who reported
with complications such as obesity or preeclampsia at any stage of pregnancy also showed

increased susceptibility for C-section. Frequent visits to antenatal care facilities, pregnancy

complications and the mode of delivering a baby through c-section are strongly associated.

The findings of our study also suggest that our healthcare system should give doctors precise

medical instructions for carrying out c-section deliveries. Strictly following those medical

recommendations will aid in lowering the number of caesarean sections performed in Pakistan's

public and private hospitals. Additionally, as part of antenatal care, awareness programs can

educate women about pregnancy risks and birth giving procedures, which tends to reduce the use

of unnecessarily caesarean deliveries that are not medically indicated.

References

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disorders. Pediatrics. 2015. January;135(1):e92–8
2. Zhang T, Sidorchuk A, Sevilla-Cermeno L, Vilaplana-Perez A, Chang Z, Larsson H, et
al. Association of Cesarean Delivery With Risk of Neurodevelopmental and Psychiatric
Disorders in the Offspring: A Systematic Review and Meta-analysis. JAMA Netw Open. 2019.
August 2;2(8):e1910236. 
3. Wainstock T, Walfisch A, Shoham-Vardi I, Segal I, Sergienko R, Landau D, et al. Term
Elective Cesarean Delivery and Offspring Infectious Morbidity: A Population-Based Cohort
Study. Pediatr Infect Dis J. 2019. February;38(2):176–80.
4. Mueller NT, Zhang M, Hoyo C, Ostbye T, Benjamin-Neelon SE. Does cesarean delivery
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