Prevalence and determinants of caesarean section in a teaching hospital of Pakistan.

A retrospective analysis of 10 863 caesarean sections was carried out at a teaching hospital in Pakistan to examine the factors responsible for the high caesarean section rate. The caesarean section rate (CSR) during the study period (1985-1996) was 24.1/100 births and 78% of the caesareans were emergency procedures. The caesarean section rate was significantly higher among primigravida (27.26%) compared with 22.31% in multipara (P<0.01). Even for each indication, the frequency of caesarean section was higher among prinigravida (P<0.05). The three leading indications were dystocia (6.32%), repeat section (5.8%) and fetal distress (3.5%). Specific socio-demographic and child bearing patterns of our women, flaws in antenatal surveillance, ineffective working of the referral chain and departmental polices regarding management of cases with dystocia, Previous, abdominal delivery and fetal distress seem to be the major underlying causes of the high CSR.