Analysis of Risk Factors and Outcomes in Emergency Cesarean Sections: A One-Year Cross-sectional Study
Keywords:
Emergency cesarean section, maternal outcomes, neonatal outcomes, risk factors, emergency classificationAbstract
Introduction: Emergency cesarean section (ECS) represent critical intervention in obstetric care with unique risk profiles. Understanding the relationship between specific indications and subsequent outcomes is crucial for optimizing clinical decision-making and resource allocation.
Methods: This hospital-based cross-sectional study was conducted at a tertiary care teaching hospital over one year, including 294 women who underwent emergency cesarean section. Data was collected using a structured proforma capturing demographic details, obstetric history, indications, and outcomes.
Results: The majority of women were 20-25 year age group(38.1%), from rural areas (59.2%), among which 33.3% were unbooked. Fetal distress (26.5%), non-progress of labor (17.7%), and failed induction (12.9%) were the leading indications. Category 2 emergencies (53.7%) predominated, followed by Category 3 (24.5%) and Category 1 (17.3%). Maternal complications included post-operative fever (14.6%), surgical site infections (10.5%), and postpartum hemorrhage (9.2%). Neonatal outcomes revealed 12.9% with 5-minute Apgar scores below 7 and 22.8% requiring NICU admission. Advanced maternal age, unbooked status, preterm delivery, Category 1 emergency classification, delayed intervention in urgent cases, antepartum hemorrhage, severe preeclampsia, and general anesthesia use emerged as an independent predictors of adverse outcomes.
Conclusion: Significant maternal and neonatal morbidity was observed following emergency cesarean section. The study highlights critical areas for quality improvement, including strengthened antenatal care, standardized fetal monitoring protocols, optimized emergency workflows, and evidence-based management of high-risk conditions to improve maternal and neonatal outcomes in emergency obstetric care.
Downloads
References
Betran, A. P., Ye, J., Moller, A. B., Souza, J. P., & Zhang, J. (2021). Trends and projections of caesarean section rates: Global and regional estimates. BMJ Global Health, 6(6), e005671. https://doi.org/10.1136/bmjgh-2021-005671.
Boatin, A. A., Cullinane, F., Torloni, M. R., & Betran, A. P. (2018). Audit and feedback using the Robson classification to reduce caesarean section rates: A systematic review. BJOG: An International Journal of Obstetrics & Gynaecology, 125(1), 36-42. https://doi.org/10.1111/1471-0528.14774.
Boerma, T., Ronsmans, C., Melesse, D. Y., Barros, A. J. D., Barros, F. C., Juan, L., Moller, A. B., Say, L., Hosseinpoor, A. R., Yi, M., de Lyra Rabello Neto, D., & Temmerman, M. (2018). Global epidemiology of use of and disparities in caesarean sections. The Lancet, 392(10155), 1341-1348. https://doi.org/10.1016/S0140-6736(18)31928-7.
Keag, O. E., Norman, J. E., & Stock, S. J. (2018). Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Medicine, 15(1), e1002494. https://doi.org/10.1371/journal.pmed.1002494.
Mascarello, K. C., Horta, B. L., & Silveira, M. F. (2017). Maternal complications and cesarean section without indication: Systematic review and meta-analysis. Revista de Saúde Pública, 51, 105. https://doi.org/10.11606/s1518-8787.2017051000389.
Mazzoni, A., Althabe, F., Gutierrez, L., Gibbons, L., Liu, N. H., Bonotti, A. M., Izbizky, G. H., Ferrary, M., Viergue, N., Vigil, S. I., Zalazar Denett, G., & Belizán, J. M. (2017). Women's preferences and mode of delivery in public and private hospitals: A prospective cohort study. BMC Pregnancy and Childbirth, 17(1), 42. https://doi.org/10.1186/s12884-017-1223-y.
Mylonas, I., & Friese, K. (2015). Indications for and risks of elective cesarean section. Deutsches Ärzteblatt International, 112(29-30), 489-495. https://doi.org/10.3238/arztebl.2015.0489.
Preetkamal, Kaur, J., & Mohi, M. K. (2017). Predictors and outcomes of emergency cesarean section: A study at a tertiary care referral institute. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 6(7), 3196-3201. https://doi.org/10.18203/2320-1770.ijrcog20172952.
Sandall, J., Tribe, R. M., Avery, L., Mola, G., Visser, G. H., Homer, C. S., Gibbons, D., Kelly, N. M., Kennedy, H. P., Kidanto, H., Taylor, P., & Temmerman, M. (2018). Short-term and long-term effects of caesarean section on the health of women and children. The Lancet, 392(10155), 1349-1357. https://doi.org/10.1016/S0140-6736(18)31930-5.
Singh, P., Hashmi, G., & Swain, P. K. (2019). High prevalence of cesarean section births in private sector health facilities: Analysis of district level household survey-4 (DLHS-4) of India. BMC Public Health, 19(1), 777. https://doi.org/10.1186/s12889-019-7137-z.
Tolcher, M. C., Johnson, R. L., El-Nashar, S. A., & West, C. P. (2014). Decision-to-incision time and neonatal outcomes: A systematic review and meta-analysis. Obstetrics & Gynecology, 123(3), 536-548. https://doi.org/10.1097/AOG.0000000000000132.
Yadav, R. G., & Rawal, A. (2020). Analysis of indications of cesarean section in a tertiary care center of North India. Journal of Clinical and Diagnostic Research, 14(2), 10-13. https://doi.org/10.7860/JCDR/2020/43321.13549.
Arora, S., Dewan, P., & Gupta, M. (2020). Comparison of short-term outcomes in preterm versus term emergency cesarean deliveries: A prospective cohort study. Indian Journal of Pediatrics, 87(8), 592-599. https://doi.org/10.1007/s12098-020-03231-0.
Bhatia, M., Banerjee, K., Dixit, P., & Dwivedi, L. K. (2020). Assessment of variation in cesarean delivery rates between public and private health facilities in India from 2005 to 2016. JAMA Network Open, 3(8), e2015022. https://doi.org/10.1001/jamanetworkopen.2020.15022.
Chaudhary, S., Contag, S., & Yao, R. (2021). Maternal and neonatal outcomes in emergency versus elective cesarean sections: A retrospective analysis of 3,842 cases. International Journal of Gynecology & Obstetrics, 154(1), 94-100. https://doi.org/10.1002/ijgo.13548.
Desai, P., Srivastava, R. K., Soni, S. T., & Garg, S. (2022). Changing trends in indications of cesarean section: A hospital-based analysis. Journal of Obstetrics and Gynecology of India, 72(1), 56-63. https://doi.org/10.1007/s13224-021-01570-2.
Deshpande, H. G., Madkar, C. S., & Dahiya, P. (2021). Implementation and impact of standardized fetal heart rate monitoring interpretation in a tertiary care center. Indian Journal of Obstetrics and Gynecology Research, 8(3), 328-334. https://doi.org/10.18231/j.ijogr.2021.068.
Garg, R., Thakor, N., & Sharma, D. (2019). Comparative study of feto-maternal outcome between emergency and elective cesarean sections in a rural tertiary care referral center. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 8(2), 626-631. https://doi.org/10.18203/2320-1770.ijrcog20190295.
Jain, M., Patel, A., Rupani, M., & Jain, A. (2021). Incidence and risk factors for surgical site infections following cesarean sections at a tertiary care hospital. International Journal of Infection Control, 17(1), 1-8. https://doi.org/10.3396/ijic.v17i1.023.21.
Kavitha, G., Prasad, D. K. V., & Reddy, N. S. S. (2020). Maternal and neonatal outcomes in booked versus unbooked patients: An institutional study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 9(3), 1188-1192. https://doi.org/10.18203/2320-1770.ijrcog20200896.
Khunpradit, S., Patumanond, J., & Tawichasri, C. (2019). Development of risk scoring scheme for prediction of cesarean delivery due to cephalopelvic disproportion in Lamphun Hospital, Thailand. Journal of Obstetrics and Gynaecology Research, 45(8), 1490-1497. https://doi.org/10.1111/jog.14001.
Kumar, S., Kumar, A., & Jain, S. (2018). Failed induction of labor: A systematic review and meta-analysis of factors associated with cesarean delivery. Journal of Gynecology Obstetrics and Human Reproduction, 47(8), 361-366. https://doi.org/10.1016/j.jogoh.2018.05.004.
Lakshmi, S. D., Venkata, R. M., & Kumari, V. S. (2022). Comparative study of maternal and perinatal outcomes according to urgency of cesarean delivery based on RCOG classification. Journal of Family Medicine and Primary Care, 11(2), 612-617. https://doi.org/10.4103/jfmpc.jfmpc_2137_21.
Madhavi, K., Kaza, F., Lokeswari, V., & Ramaiah, I. A. (2021). Unbooked status: A risk factor for maternal and perinatal outcome. Journal of Clinical and Diagnostic Research, 15(6), QC01-QC05. https://doi.org/10.7860/JCDR/2021/47621.14961.
Mahajan, N., Chaudhari, B., & Laddad, M. (2020). Maternal mortality in a tertiary care center due to hypertensive disorders in pregnancy: Five-year retrospective study. Journal of Obstetrics and Gynecology of India, 70(3), 244-248. https://doi.org/10.1007/s13224-020-01323-7.
Mehta, A., Agrawal, A., Patel, K., & Domkundwar, S. (2021). Effect of antenatal care on emergency cesarean section outcomes: A prospective observational study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 10(3), 1035-1040. https://doi.org/10.18203/2320-1770.ijrcog20210737.
Narain, M., Gupta, S., & Bagga, R. (2023). Association between decision-to-delivery interval and perinatal outcomes in emergency cesarean deliveries: A multicenter prospective study. International Journal of Gynecology & Obstetrics, 160(2), 557-563. https://doi.org/10.1002/ijgo.14231.
Prasad, D., Nishat, H., & Prakash, A. (2020). Effect of community-based antenatal care interventions on institutional delivery rates: Results from a cluster randomized trial. BMC Pregnancy and Childbirth, 20(1), 309. https://doi.org/10.1186/s12884-020-03001-y.
Ramachandran, A., Raja, D. K., & Babu, P. R. (2021). Pregnancy outcomes by the new four-category classification of urgency of cesarean section: A multi-center study. Journal of Clinical and Diagnostic Research, 15(5), QC01-QC05. https://doi.org/10.7860/JCDR/2021/46923.14841.
Reddy, S., Manjunath, M., & Bhat, S. (2019). A study of maternal and fetal outcomes in emergency cesarean section versus elective cesarean section. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 8(12), 4779-4783. https://doi.org/10.18203/2320-1770.ijrcog20195321.
Sharma, R., Dogra, P., & Bhardwaj, A. K. (2022). Changing trends and safety of vaginal birth after cesarean delivery: A 10-year retrospective study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 11(1), 89-94. https://doi.org/10.18203/2320-1770.ijrcog20220040.
Verma, A., Dhingra, S., & Pandey, K. (2022). Implementation of "Code Cesarean" protocol to reduce decision-to-delivery interval in emergency cesarean section: A quality improvement initiative. International Journal of Gynecology & Obstetrics, 156(2), 282-288. https://doi.org/10.1002/ijgo.13696.
Viswanath, A., Srinivas, M., & Rajesh, A. (2021). Maternal and neonatal outcomes in emergency cesarean section: A comparative study across five tertiary care centers in South India. Journal of Obstetrics and Gynecology of India, 71(3), 283-290. https://doi.org/10.1007/s13224-021-01490-1.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
