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

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.