Rising Caesarean section Rates

in Malaysia
Shamala Devi Karalasingam,Ravindran Jegasothy, Ravichandran Jeganathan
4
Nur Amirah Zolkepali , Sharul Aiman 5

1 CRC National, 2 Hospital Kuala Lumpur, 3 Hospital Sultanah Aminah, Johor ,

4 CRC National , 5 CRC National
Percentage of Birth Asphyxia in Breech
Introduction 30
Discussions
The rising Caesarean section (CS) 26.88
The decision to perform CS should be for
25
rate is a global phenomenon and in obstetric indications. All Site Data
Malaysia too the rates have been 20
Percentage
Providers should audit their CS rates and
gradually increasing. The WHO 15 develop guidelines to reduce rates. There
11.15
consensus in 1985 for CS suggested 10 has been an increase in medically
that 15% was a reasonable rate. 5
indicated Caesarean delivery in recent
This is now out dated and needs decades and this is seen with patients in
0
revision. Caesarean Vaginal this review. There is a higher perinatal
Mode of Delivery
mortality and morbidity with breech than
Methodology Chart 2: Percentage of Birth Asphyxia in Breech cephalic presentation due to birth
babies following Caesarean Section and Vaginal
This is a review looking at CS rates delivery asphyxia (Chart 2) as well as trauma and
from 14 tertiary hospitals in 2010 CS for breech has been suggested as a way
ECV for Breech
from the National Obstetric to reduce this. To reduce breech
Registry. There were a total of Missing
Done presentation at term, external cephalic
7%
138,315 deliveries analysed from 18% version (ECV) should be advocated and
1st January 2010 to 31st Dec 2010. Not Available this in turn will reduce CS rates. In the

National Obstetrics Registry (NOR)

13%
current practice, breech babies are
Results Not Done increasingly delivered by CS. Hence
CS rates from the 14 tertiary 62%
policies should be implemented to
hospitals was 23.08% . Two increase the number of women offered
previous CS accounted for 11.21% and undergoing ECV. The decision to
of all CS whilst one previous CS Chart 3: Shows the Percentage of ECV done as perform Caesarean section has
accounted for 15.6%. More than compared to not done
implications on maternal morbidity in the
half of the patients as seen in Table Indications for Caesarean Section current pregnancy as well mode of
1 with one previous CS had a 35.00
32.49
delivery in subsequent pregnancies.
repeat CS. Approximately one 30.00
Caesarean section is not the safest option
fourth of CS was for Diabetes and 25.00
for delivery unless it is being done for a
Hypertension complicating
Percentage

20.00
valid obstetric indication. Therefore steps
pregnancy. 61.8% of patients with 15.00
11.90
14.71
must be taken to reduce primary
breech did not have ECV and hence 10.00 9.18 9.86
caesarean section.
5.88
accounted for 11.9% of CS. 5.00 4.32

Caesarean Section Rates 0.00 References

Fetal Distress Poor Progress Placenta Macrosomia Breech Hypertension Diabetes
35.00 31.99 32.32 Previa Major
and Minor
1. World Health organization. Appropriate
28.80
30.00
25.88
24.36 23.17
26.26
24.17 Chart 4: Indications for Caesarean Section technology for birth. Lancet 1985;ii 436-7
25.00 21.86 22.35
20.34 2. Hannah ME, Hannah WJ. Planned
Percentage

20.00 18.71
17.00 15.78 Previous SVD + Caesarean section Caesarean
15.00 Caesarean Instrumental rates caesarean section versus planned vaginal
LSCS Classical Hysterotomy
Section (VBAC)
10.00
n % n % n % n %
breech presentation at term: a
5.00
1 Previous 4603 (48.9%) 4,798 15.4 37 22.7 1 4.16 4,836 15.5
randomised multicentre trial. Term Breech
0.00
LSCS
Total cases :
Trial Collaboration Group. Lancet 2000;
9472 356:1375-83
Source Data Provider 2 Previous 3443 11.1 28 17.1 5 20.8 3,476 11.1
LSCS 619 (15%)
Chart 1: Caesarean section from tertiary hospital Total cases :
in all States 4114

Table 1: Shows Mode of delivery for patients

with previous LSCS