title: Primary caesarean section in nulliparous and grandmultiparous Saudi women from the Abha region: indications and outcomes.
abstract: OBJECTIVE
  To assess the indications for and outcomes of primary caesarean section (PCS) perfomed in nulliparous and grandmultiparous women in the Abha region of Saudi Arabia.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  393 nulliparous women (para 0) (NPG) and 432 grandmultiparous women (parity>5) (GMPG) who had PCS at the Abha Maternity Hospital (AMH) over a 3-year period, (1997-1999) formed the basis of the study.
  
  
  RESULTS
  The PCS rates in NPG and GMPG were 19.4% and 18.3% respectively with no statistically significant difference. (p>0.05). There were statistically significant differences between the two groups regarding the mean age, blood loss during surgery, post operative haemoglobin, and birth weight were compared, p<0.05. There was no statistically significant differences in the mean gestation at delivery, p>0.05. The most common indication for surgery in the two groups of patients was fetal distress (NPG=28%, GMPG=25%: p=NS), followed by failure of progress in labour. (NPG=22.7%, GMPG =21.6%, p=NS). Antepartum haemorrhage (APH) was the indication for PCS in 6.8% of the NPG and 13.9% of the GMPG, (p<0.05). Multivariate linear regression analysis indicated that maternal age and booking status significantly affected birth weight (p=0.004,p=0.022 respectively). However, neither birth weight nor low Apgar score was affected by the indications for CS or parity. While there were no perinatal deaths in the series, no statistically significant difference was found between the two groups with regards to low Apgar score (<7 at 5 mins), p>0.05.
  
  
  CONCLUSIONS
  The major indications for PCS were the same in the NPG and GMPG in our study while the CS rates were similar in both groups. However, APH and its inherent complications occured more commonly in the GMPG. Neonatal morbidity was similar in both groups of women, but the mean birth weight was significantly higher in the GMPG. However, in order to reduce the high CS rate in these groups of patients, and in our obstetric population in general, it is suggested that CTG be used appropriately in high risk women and that intermittent auscultation is recognized as a valid form of management for most low risk cases.
authors.affiliation: Department of Obstetrics and Gynaecology, College of Medicine and Medical Sciences, King Khalid University, PO Box 641, Abha, Saudi Arabia.
authors.forename: A A
authors.initials: AA
authors.lastname: Sobande
authors.forename: E I
authors.initials: EI
authors.lastname: Archibong
authors.forename: M
authors.initials: M
authors.lastname: Eskandar
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008423:Maternal Age; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies; D012529:Saudi Arabia / Q000453:epidemiology