STUDY OF APPROPRIATENESS OF CAESAREAN SECTIONS PERFORMED AT MATERNITY UNIT OF LARGE TEACHING HOSPITAL USING THE RAND APPROPRIATENESS METHOD CRITERIA

Abstract

Introduction: Caesarean section has been defined as delivery of the foetus through a surgical incision into the uterine wall after 28 weeks of gestation. C.S is defined as appropriate when it meets at least one criterion for appropriateness as defined by the criteria developed. The caesarean section rate has risen considerably over the past few decades from less than 7% in the 1970s to over 25% in 2003, causing major concerns for health policymakers. The ideal rate for caesarean sections is between 10% and 15%. This was based on the following statement by a panel of reproductive health experts at a meeting organized by the WHO in 1985 in Fortaleza, Brazil: “There is no justification for any region to have a rate higher than 10-15%”.

Study Design and Settings: Prospective observational study was conducted in Maternity unit of SKIMS.

Aims and Objectives:

1. To determine the appropriateness of caesarean sections.
2. To analyze the different indications of caesarean section.

 Materials and Method:

A prospective observational study for a period of one yr (from Ist October 2017 to 30^th September 2018) was carried out in maternity unit of SKIMS, Using a modified version of RAND criteria called as RAM, All the patients undergoing C.S were studied.

Results: A total of n=1620 C.S were conducted in this period out of which 26(1.61%) were found to be inappropriate and 1594(98.39%) were found to be appropriate. 29.75% of patients had repeat C.S, 10.18% of patients had foetal distress, 9.01% of patients had Cephalopelvic disproportion, 4.32% of patients had Breech presentation and 6.79% patients had failed induction.

Conclusion:  In view of the results of the study it has been shown that the percentage of the appropriateness of C.S is 98.60%, which clearly shows that no misuse of C.S facility has been done in SKIMS.