Publication:

Study of the indications for caesarean sections between 20 and 28 weeks of gestation

Background Major change in the practice of obstetrics over the past century is progressive increase in the frequency of caesarean delivery and recent scientific information show improved survival or decreased morbidity for the neonate when caesarean delivery is performed for extreme prematurity. This study was done to determine the caesarean section rate for sections done between 20 and 28 weeks of gestation and to analyze the indications for such sections.

Methods Institutional based retrospective observational study done in the Obstetrics and Gynaecology Department, Cheluvamba Hospital, MMC&RI, Mysore, Karnataka, India. Caesarean sections done over 5 years from January 1st 2010 till December 31st 2014 are considered for the study. The total number of Caesarean sections done for gestational age between 20 and 28 weeks are noted. The data obtained is analyzed for the indications at the respective gestational ages.

Results Frequency of caesarean section at gestational age between 20 and 28 weeks is seen to be <1%. Out of total 15,906 LSCS cases, 97 (0.6%) patients under went caesarean section between 20 and 28 weeks of gestation. Of the 97 cases, 54 cases (55.67%) were operated at 28 weeks, 17 cases (17.52%) at 26 weeks, 20 cases (20.61%) at 24 weeks, 4 cases (4.12%) at 22 weeks and 2 cases (2.06%) at 20 weeks of gestation. APH in 33 (34.0%), pre-ecclampsia and ecclampsia in 30 (30.9%) cases are found to be the indications for delivery in 61 cases (64.9%). The indications for caesarean sections in 44 (45.3%) cases were previous caesarean section associated with or without pre-ecclampsia and APH as contributory factors.

Conclusions Caesarean section rate for gestational age between 20 and 28 weeks’ gestational age is <1% and there is decreasing trend. Previous caesarean section, APH, ecclampsia and pre-ecclampsia with their complications are the common indications for such sections. The decision to perform first caesarean section and the indication for it is of prime importance.