0

INDICATIONS FOR EMERGENCY CESAREAN SECTION AND ASSOCIATED CLINICAL MATERNAL AND
NEONATAL OUTCOMES AT WVSU-MC: A THREE-YEAR RETROSPECTIVE STUDY

OMAMALIN NG, ALCIDO MR, SUIB SJ, ORDONA MG, ARANDA D, DOLENDO V, HINOJALES R,
PANELO RM
College of Medicine, West Visayas State University, Iloilo City, Philippines

ABSTRACT

BACKGROUND: Pregnancy and parturition are events of considerable importance in the life cycle of women.
Cesarean section (CS) carries a higher maternal morbidity and mortality compared to vaginal delivery.
Given the rising global incidence of cesarean section, this study aims to reveal the clinical profile of
women undergoing ECS, the leading indications for ECS and the consequent maternal and neonatal
outcomes following ECS.

OBJECTIVE: To determine the leading indications for ECS and their associated maternal and neonatal
outcomes in West Visayas State University (WVSU-MC) from January 2005 to December 2007.

METHODOLOGY: The leading indications for E CS were determined in terms of frequency and percentage.
Clinical outcomes of the subjects and the delivered newborns were gauged by maternal mortality and
survival rates (i.e. within the hospital confinement) and APGAR scores (1 and 5 minutes), respectively.

STUDY SETTING: Data were collected from the records section of WVSU-MC and processed at the WVSU
College of Medicine, La Paz, Iloilo City

RESULTS: A total of 703 cesarean section procedures were performed from 2005-2007. Ninety-one (91%)
percent of these were ECS. Records of patients who underwent ECS were retrieved and comprised the
study population (N=533). The means of the age, gravidity and parity of the parturients studied were
29.9 yrs, 2.03, and 1.8, respectively. The mean age of gestation of neonates is 37.8 weeks. Neonates
delivered via ECS are mostly term (69.2%) with good APGAR scores 7-10 (94.4%) at 1 and 5 minutes..
Dystocia (30.8%) emerged as the leading indication for ECS followed by malpresentation (23.8%) and
repeat CS (17.3%). Hypertension was the most frequent morbidity to affect women who delivered via ECS.
Parturients with hypertensive disease underwent ECS due to dystocia. The clinical outcome of ECS is
favorable for both the mother and the child. Survival is 97.4% and 97.2% for parturients and neonates,
respectively. Similarly, mortality rate is less than 1% for both parturients and neonates.

CONCLUSIONS: Dystocia is the most common indication for ECS among women of reproductive age,
primigravid, primaparous and with no illness during pregnancy. Survival is 97.4% and 97.2% for parturients
and neonates, respectively. Mortality rate is less than 1% for both parturients and neonates. Non-
reassuring fetal tracing was the most frequent indication leading to death of both parturients and
neonates.


KEYWORDS: Emergency Cesarian Section, Indications, Clinical Maternal and Neonatal Outcome



1

INTRODUCTION
BACKGROUND OF THE STUDY
Pregnancy and parturition are events of considerable importance in the life cycle of women.
Pregnant women may deliver their children via normal spontaneous vaginal delivery or through
cesarean section. Parturition or giving birth is physiological; however, it poses a significant risk to the life
and well-being of both mother and child. Of all deliveries, however, approximately 10% are considered
high-risk, some of which require cesarean section.
1
Þanllllo eL al. descrlbes Cesarean secLlon (C“) as ºLhe
delivery of a fetus through an abdominal incision (laparotomy) followed by incision of the uterine wall
(hysterotomy)."
2
This definition excludes operation involving abdominal incision that aims to take out
the fetus from the abdomen during abdominal pregnancy or dislodgment of fetus in the abdominal
cavity when there is rupture of uterus.
CS is further divided into two sub-types as far as the urgency of operation is concerned. Elective
CS refers to ºLhose occaslons where a cesarean ls conducLed as a resulL of advanced plannlng."
3
It also
refers to a decision made more than 24 hours before delivery.
4
An elective cesarean, due to its non-
emergency situation, may be perceived by the woman giving birth as a calm and positive experience.
Emergency cesarean section (ECS), on the other hand, is defined as any cesarean delivery that is
not planned or scheduled.
4
A cesarean operation is considered an emergency if decisions are made
during the 24 hours before the delivery because of deteriorating fetal or maternal health before the
onset of labor.
4
Indications for this non-elective CS are usually evident only after the onset of labor,
either in the early stage or after a woman has been in labor for a while. Since time is critical in this
operation, several studies attempted to set the standard interval time from the date and time of

decision to carry out the cesarean section to the date and

time of delivery of the baby. The present
acceptable delivery interval is 30 minutes, although other studies have found out that even beyond this
period, as long as it does not exceed 75 minutes, emergency CS outcomes are still favorable.
5, 6


Rising Incidence of Cesarean Section
The incidence of cesarean section is steadily rising. In the last few decades, the cesarean rates
have increased dramatically in the developed world. The World Health Organization estimates that
2

the rate of cesarean sections is between 10% and 15% of all births in developed countries. In 2001–
2002, the Canadian cesarean section rate was 22.5%.
7
In 2004, the cesarean rate was about 20% in the
United Kingdom. In 2005, the cesarean rate was 30.2% in the United States and has been increasing
since 1996.
8

Among developing countries like Brazil, cesarean section rates have also increased. In the public
health network, the rate reaches 35%, while on the private hospitals network, the rate of cesarean
sections is at 79.6%.
8
In India, data collected from 30 medical colleges/ teaching hospitals revealed that
cesarean section rates increased from 21.8% in 1988-1989 to 25.4% in 1993-1994
9
. In a population
based cross-sectional study conducted in India, a cesarean section of 32.6% has been documented from
Madras City in South India.
10

In the Philippines, an increasing trend of CS is also evident. In 1927-1950, the Philippine General
Hospital recorded a one percent increase in the incidence of CS.
11
From 1945-1951, in the same
institution, CS constituted 3.06 percent of 25,183 deliveries. From UST Hospital
11
and North General
PosplLal, Lhe average was 3.3 percenL and 9.2 percenL ln Lhe 1960’s.
11,12,13
The Philippine Obstetrical
and Gynecological Society

explained the following reasons for the increasing trend of CS in the
Philippines: increasing safety of the operation due to antibiotics; availability of blood transfusions;
beLLer anesLhesla and Lhe physlclan’s hlgh lnLenL Lo dellver a healLhy baby and healLhy moLher, when
done for complications occurring during pregnancy and labor; preference for CS in the delivery of
breech, Lhe aLLlLude of Lhe physlclan Lowards Lhe concepL of ºCnce a cesarean always a cesarean", and
the attitude of the physician toward the diagnosis of fetal distress, especially when using the electronic
fetal monitor as a basis for the diagnosis.
14


Cesarean Section and Associated Maternal and Fetal Outcomes
It is well documented that cesarean section carries a much higher maternal mortality and
morbidity as compared to a vaginal delivery.
15
Even though cesarean section is being performed
for indications like fetal distress, perinatal mortality continues to be very high in cesarean
section deliveries.
3

A study published in the February 2007 issue of the Canadian Medical Association Journal found
that women who underwent elective CS had an overall rate of severe morbidity of 27.3 per 1000
deliveries compared to an overall rate of severe morbidity of 9.0 per 1000 planned vaginal deliveries.
The elective cesarean group had increased risks of cardiac arrest, wound hematoma, hysterectomy,
major puerperal infection, anesthetic complications, venous thromboembolism, and hemorrhage
requiring hysterectomy over those suffered by the planned vaginal delivery group.
16

In a prospective observational study of 8070 elective cesarean sections in Malawi, Africa, 85
women died after CS, giving a mortality of 1.05%.
17
In 1982, maternal mortality in one district of Malawi
was reported

as 420/100, 000 pregnancies, and in 1992 in the whole of Malawi

it was 620/100,000.
17,18
It
has since risen to an estimated 1120

per 100, 000 compared with 10 per 100, 000 in developed
countries.

Cesarean section has a much higher mortality for mother and

baby in Africa than in
industrialized countries.
19
Other complications

believed to contribute to mortality were intra-operative
hypotension

(64, 75% of deaths), operative hemorrhage (45, 53% of deaths), ventilation

difficulty (12,
14%), regurgitation of stomach contents (11,

13%), pre-eclampsia (7, 8% of deaths), and difficult
intubation (1, 1% of deaths).

In 65 (77% of deaths) cases in which the mother died, the baby also died.

The overall three day survival rate for all babies was 88.8%
19
.

However, not all CS cases have unfavorable outcomes. In the United Kingdom, on the other
hand, the overall death rate associated with

cesarean section fell from 40/10 000 in 1952-1954 to
4/10,000

in the 1980s
20
.
In a retrospective review of 25 consecutive emergency cesarean sections for umbilical cord
prolapse over a one-year period in a certain institution, no significant anesthetic complications such as
failed intubation or aspiration pneumonia occurred
21
. There were also no maternal surgical
complications from the cesarean sections. The mean post-operative hospital stay was 4.2 (range 2-8)
days. Two babies suffered superficial cuts in the course of the cesarean deliveries. But neither required
any sutures nor any further follow up. The researchers attributed the improved neonatal outcome to
the practice of immediate cesarean section. Improved neonatal outcome also occurred in an emergency
CS of a poor risk patient in Nepal. Although unresponsive at

birth, the child had an Apgar score of 10 at
15 min
22
.
Given the rising global incidence of cesarean section and the relatively higher morbidity and
mortality of emergency cesarean section, this study aims to determine the profile of mothers and
neonates that may predispose ECS, the leading indications for emergency CS and their associated clinical
4

outcome. As there is a dearth of local data on this matter, results of this study will serve as a baseline
for emergency CS trend in WVSU-MC.

SIGNIFICANCE OF THE STUDY
Emergency CS has been associated with increased poor maternal and fetal outcomes.
Recognition of the factors that predispose emergency CS will help in identifying pregnant women who
are at high risk for emergency CS and if possible, alter modifiable factors through education and
anticipatory prevention, so as to prevent poor clinical outcomes.
The results of this study will benefit hospitals, clinicians, and researchers in anticipating
management of the mother and her child. It also aims to influence the decision-making among
clinicians, with the hope of decreasing maternal and neonatal morbidity and mortality, lowering
personal and institutional health care costs.
This study seeks to identify the common indications for emergency CS and will fill in the lack of
local data on emergency CS and could provide a valuable contribution to national and international data.

RESEARCH QUESTION
What are the indications for emergency Cesarean section and the associated maternal and
neonatal outcomes in WVSU-MC from 2005-2007?

GENERAL OBJECTIVE
To determine the leading indications for emergency CS and the clinical maternal and neonatal
outcomes following emergency caesarian section in WVSU-MC from January 2005 to December 2007.



5

SPECIFIC OBJECTIVES
The study specifically aims to:
1) determine the profile of maternal subjects according to:
a. age
b. gravidity
c. parity
d. types of previous deliveries
e. presence of maternal illness
2) determine the age of gestation (AOG) and APGAR scores at 1 and 5 minutes of neonates
born through emergency CS;
3) determine leading indications for ECS when maternal subjects are stratified by
a. age
b. gravidity
c. parity
d. types of previous deliveries
e. presence of maternal illness

4) determine leading indications for ECS when neonates are stratified by age of gestation
(AOG); and
5) determine clinical outcome through mortality and survival rates following emergency CS of
a. maternal subjects
b. neonates


LIMITATIONS OF THE STUDY
1. Mothers whose medical records were not found were automatically removed from the study.
2. Neonates whose medical records were not found were automatically removed from the study.
3. Clinical outcomes of parturients and neonates are limited by intrahospital confinement.
4. The causes of death of parturients and neonates were not determined.



6

CONCEPTUAL FRAMEWORK

INDEPENDENT VARIABLES INTERVENING VARIABLE DEPENDENT VARIABLES




















MATERNAL AGE
GRAVIDITY
PARITY
MATERNAL ILLNESS
TYPE OF PREVIOUS
DELIVERIES
AGE OF GESTATION
MATERNAL OUTCOME

NEONATAL OUTCOME
MEASURED WITH
APGAR SCORE


INDICATIONS FOR
ECS
7

MATERIALS AND METHODS
STUDY DESIGN
A 3-year retrospective cross sectional design was employed in this study.

STUDY SETTING
This study was done in West Visayas State University Medical Center (WVSU-MC) in Iloilo City.

STUDY PERIOD
This study was conducted from September 2008 to February 2009.

STUDY POPULATION
Inclusion Criteria
All emergency cesarean deliveries documented from January 2005-December 2007 in the West
Visayas State University Hospital constitute the sample population.

Exclusion Criteria
All elective cesarean section deliveries from January 2005-December 2007 in WVSU-MC were
excluded from the study. Missing records were dropped from the sample population.

OPERATIONAL DEFINITIONS
Age of gestation- the stage of the embryo counting from the first day of the last menstrual period. On
the average, about 2 weeks longer than conceptional age, assuming a 28-day menstrual cycle.
APGAR Score- a method for assessing the need for resuscitation and the chances for survival in
newborns, taken during the first minute of life and every five minutes thereafter.
Cesarean delivery- the delivery of a fetus through an abdominal incision (laparotomy) followed by an
incision of the uterine wall (hysterotomy). It excludes delivery of extrauterine pregnancies or
extraction of dislodged fetus in the abdominal cavity in a ruptured uterus.
Clinical outcome- the status of the patient after exposure to disease or as in this study, the status of
the parturient and neonate (survived or died) after the emergency CS procedure.

8

Emergency cesarean section- immediate, unplanned or unscheduled termination of pregnancy via
cesarean section for the ultimate purpose of saving the life of both the parturient and her
offspring.
Grandmultigravida- a woman with a history of more than 5 gestations or pregnancies.
Grandmultipara- a woman with a history of having more than 4 deliveries.
Gravidity- total number of pregnancies including the current pregnancy irrespective of the pregnancy
outcome.
Maternal Illnesses- comorbid conditions of the mother incurred before or during pregnancy.
Mortality rate- percentage of maternal and neonatal subjects who died immediately following
emergency cesarean section or within the duration of hospital confinement.
Multigravida- a woman with a history of 2 or more but less than 5 pregnancies
Multipara- a woman with a history of having 2 or more but less than 4 deliveries.
Parity- the total number of pregnancies reaching viability. Therefore, completion of any pregnancy
beyond the stage of abortion bestows parity upon the mother. Parity is not greater if a single
fetus, twins, or quintuplets were delivered, nor lower if the fetus or fetuses were stillborn.
Parturient- A woman in the process of giving birth or childbirth. Also known as maternal subject.
Primigravid- a woman with no previous history of conception or pregnancy other than the current
pregnancy.
Primipara- a woman with no previous history of viable pregnancies or deliveries other than the current
viable pregnancy or delivery.
Types of previous deliveries- the manner by which the previous pregnancies were delivered (i.e. vaginal,
forceps, elective cesarean, or emergency cesarean).

DATA COLLECTION METHODS AND TOOLS
Acquisition of Permit
A letter requesting for access to the OB-GYNE records from Jan. 2005-Dec. 2007 was addressed
to the Hospital Director and the Head of Records Section of the West Visayas State University-Medical
Center (WVSU-MC).


9

Log Book Review
The list of patients who underwent CS operations from January 2005-December 2007 was taken
from the log book of OB-GYNE department, which served as a guide in requesting for the individual
chart of our subjects who satisfied our inclusion criteria.
Obstetrics Chart Review and NICU Chart Review
In conducting the chart review, the maternal data collection form was filled up noting the
factors considered in the study and the survival or death of the patient within the period of
confinement. For the neonates, the age of gestation, the APGAR scores (1

and 5 minutes) of the
neonates were recorded in the neonatal data collection form. The NICU chart was also consulted to
determine survival and mortality of newborn subjects within the period of hospital confinement.

DATA PROCESSING AND ANALYSIS
Statistical Software
All data were processed using the SPSS version 16.0 and Microsoft Excel 2007.
Descriptive Statistics
Frequency and percentage of the variables under study were used to determine the most
common indication for emergency CS and the survival and mortality rates for both the parturient and
neonates. The trends and behavior of variables were also described.






10

Flow Chart of Data Collection











11

RESULTS

From January 2005 to December 2007, a total of 703 cesarean section procedures were
performed in West Visayas State University-Medical Center. Six-hundred twenty seven of these cases
(91%) were listed as emergency cesarean (ECS) deliveries in the OB-GYN Department Logbook. Records
of patients who underwent ECS were retrieved and comprised the study population (N=533).

CLINICAL PROFILE OF PARTURIENTS
Maternal Age
Table 1 shows that majority of women (80.3%) who delivered through emergency CS belong to
the 18-35 years age group. Younger women (<18 years) who underwent emergency CS accounted for
only less than 1% of all emergency cases.
The mean age of parturients who underwent ECS is 29.9 years old. The youngest among the
parturients is 16 years old while the oldest is 44 years old.

Table 1. Distribution of Parturients According to Age, Gravidity, and Parity (N=533).

FREQUENCY PERCENT
AGE GROUP (YEARS)
< 18
18-35
>35

4
428
101

0.8
80.3
18.9
GRAVIDITY
1
2
3
4
5
>5

225
156
88
32
11
21

42.2
29.3
16.5
6.0
2.1
3.9
PARITY
1
2-4
>4

253
257
23

47.5
48.2
4.3
12


Gravidity
Primigravids comprised majority of ECS deliveries (Table 1). Meanwhile, multigravids who has
been pregnant for the 5
th
time incurred the least number among ECS patients (2.1%).
Grandmultigravidas comprised only 3.9% of the total.
The mean number of gestations in patients who underwent ECS was 2.03.
Parity
Most of the women who underwent ECS are multiparas (48.2%). A slight difference exists in the
frequency of primaparas (47.5%) and multiparas (48.2%). Grandmultiparous women made up only 4.3%
of all ECS cases.
The mean number of deliveries in patients who underwent ECS was 1.8.
Type of Previous Deliveries
As shown in Figure 1, most of the parturients have a history of childbirth. Among these women,
cesarean section (26.5 %) predominates over vaginal delivery (21.6 %) as a common preceding mode of
delivery. Only 5% of the se women had given birth via both CS and vaginal deliveries prior to ECS.
Figure 1. Distribution of Parturients According to Type of Previous Deliveries (n=526).
13

Maternal Illnesses
As shown in Table 2, about 2/3 of the women who underwent ECS have no concurrent acute
and chronic illnesses with pregnancy. However, 1/3 of the population had some form of illness during
pregnancy. Hypertensive disease was the most common illness to affect women who underwent ECS.


Table 2. Distribution of Parturients According to Presence of
Illness During Pregnancy (N=533).






Figure 2. Frequency of Parturients with Illness During Pregnancy (n=350).

The three most common illnesses among women who underwent ECS are hypertensive disease,
urinary disease and endocrine disease (Table 3).
FREQUENCY PERCENT
WITH MATERNAL ILLNESS
183 34.3
WITHOUT MATERNAL ILLNESS 350 65.7
14

Table 3. Classification and Distribution of Maternal Illnesses Among Parturients
Who Delivered via ECS from 2005-2007 (n=183).
MATERNAL ILLNESS FREQUENCY PERCENT
HYPERTENSIVE DISEASE
62 33.9
Gestational HPN
Chronic HPN
Preeclampsia
URINARY DISEASE
31 16.9
Urinary Tract Infection
Urinary Stone Disease
ENDOCRINE DISEASE
26 14.2
Impaired Glucose Tolerance
Gestational Diabetes Mellitus
Hyperthyroidism
Hypothyroidism
Parathyroidism
PULMONARY DISEASE
21 11.5
Bronchial Asthma
Pneumonia
Upper Respiratory Tract Infection

GYNECOLOGIC DISEASE
15 11.5
Mullerian Duct Anomaly
Pelvic Endometriosis
Paraovarian Cyst
Adenomyosis
Paratubal Cyst
Endometrial Cyst
Breast Mass
INFECTIOUS DISEASE
10 4.9
Typhoid Fever
Hepatitis A
Hepatitis B
Varicella Infection
MULTI-SYSTEM INVOLVEMENT
10 4.9
Endocrine And Gynecologic
Hypertensive, Endocrine And Pulmonary

Endocrine And Urinary
Hypertensive, Urinary And Pulmonary
Hypertensive And Heart Disease

CARDIAC DISEASE
6 3.3
Mitral Regurgitation
Rheumatic Heart Disease
OTHERS
4 0.8
Slipped Disk, Scoliosis, Psychiatric Disorder
15

AGE OF GESTATION AND APGAR SCORES AT 1 AND 5 MINUTES NEONATES BORN THROUGH ECS

Table 4 shows that majority (69.2%) of neonates born through ECS are term, within 37-42
weeks. The mean age of gestation of neonates delivered via ECS is 37.8 weeks.
Majority of neonates have APGAR scores of 7-10 at 1 minute (88.2%) and 5 minutes (94.4%).

Table 4. Age of Gestation and APGAR Scores of Neonates Delivered via ECS
at 1 and 5 minutes (N=534).


CLINICAL OUTCOME OF PARTURIENTS AND NEONATES

Table 5 shows that majority of parturients (97.4%) survived following ECS while less than 1%
died. Parturients who went home against medical advice comprised 2.1% of all the cases.

Table 5. Clinical Outcome of Maternal Subjects and Neonates Following
ECS (N=533).

FREQUENCY PERCENT
AGE OF GESTATION (WEEKS)
< 28
28-36
37-42
>42

7
121
369
8

1.3
22.7
69.2
1.5
APGAR SCORE 1 MIN
0-3
4-6
7-10

16
31
470

3.0
5.8
88.2
APGAR SCORE 5 MIN
0-3
4-6
7-10

9
5
503

1.7
0.9
94.4
FREQUENCY PERCENT
PARTURIENTS
Survived
Died
Discharged Against Medical Advice

519
3
11

97.4
0.6
2.1
NEONATES
Survived
Died

519
15

97.2
2.8
16

Among neonates delivered via ECS, majority (97.2%) survived while only 2.8% died (Table 5).
Majority of the fatalities had APGAR scores 0-3 at 1 minute (62.5%) and 5 minutes (88.9%) (Table 6).

Table 6. Clinical Outcomes of Neonates Based on APGAR Scores at 1 and
5 minutes (N=534).
APGAR SCORES
1 MINUTE 5 MINUTES
Survived Died Survived Died
0-3 37.5 62.5 11.1 88.9
4-6 90.3 9.7 60.0 40.0
7-10 99.6 0.4 99.0 1.0


Clinical outcomes of neonates who had APGAR scores below 7 in the maternal chart were
further verified using the neonatal chart. Out of the 47 neonates with < 7 APGAR scores, 15 (31.9%) died
(Table 6).
Table 7. Clinical Outcomes of Neonates with <7 APGAR Scores (n=47).
CLINICAL OUTCOMES FREQUENCY PERCENT
Survived
Died
32
15
68.1
31.9





LEADING INDICATIONS FOR EMERGENCY CESAREAN SECTION

Dystocia (30.8%) emerged as the most common indication for ECS (Table 8). Malpresentation is
second only to dystocia as the leading indication for ECS. Furthermore, repeat CS (in labor) ranked third
among the indications for ECS (17.3%).







17

Table 8. Indications for Emergency Cesarean Section, 2005-2007
(N=533).
INDICATIONS FREQUENCY PERCENT
Dystocia 164 30.8
Arrest of Cervical Dilatation 92 17.3
Arrest of Descent 28 5.3
Cephalo-pelvic disproportion 24 4.5
Failure of descent 9 1.7
Midplane contraction 4 0.8
Prolonged latent phase 3 0.6
Failed induction of labor 2 0.4
Protracted active phase 2 0.4
Fetal Malpresentation 127 23.8
Breech Presentation 114 21.4
Transverse Lie 13 2.4
Repeat CS in Labor 92 17.3
Non-reassuring fetal tracing 75 14.1
Others 43 8.4
Placenta previa 19 3.6
PROM 12 2.3
Oligohydramnios 5 0.9
Polyhydramnios 3 0.6
Placenta previa marginalis 2 0.4
Abruption placenta 2 0.4
Bicornuate uterus 1 0.2
Presence of Maternal Illness 25 4.7
Severe pre-eclampsia 22 4.1
HELLP 1 0.2
Ischemic Heart Disease 1 0.2
Multiple Myoma Uteri 1 0.2
Fetal Problem 7 1.4
Fetal Macrosomia 2 0.4
Fetal hydrocephaly 2 0.4
Hydrops fetalis
Fetus with sacrococcygeal teratoma
1
1
0.2
0.2
Fetal cystic hygroma 1 0.2






18

MATERNAL FACTORS AND LEADING INDICATIONS FOR EMERGENCY CESAREAN SECTION

Dystocia is the most common indication among parturients in the reproductive age group, 18-
35 (31.4%) as well as among mothers aged greater than 35 (29.7%). Among maternal subjects aged less
than 18, dystocia, fetal malpresentation, non-reassuring fetal tracing and fetal anomaly are equally
represented (25%).
Among primigravids, dystocia ranked as the most common indication for ECS, followed by
malpresentation and non-reassuring fetal tracing.. As the number of gestations increased to 2 and 3,
dystocia was replaced with repeat CS (in labor) as the most frequent indication for ECS. The peak of
repeat CS cases was at the 2
nd
and 3
rd
pregnancies. By the 4
th
pregnancy, a sharp decline is seen which
eventually continues with increasing number of gestations. With increasing gestations, malpresentation
emerges as a more frequent indication for ECS.
Table 8. Maternal Factors and Leading Indications for ECS (N=533)

MATERNAL FACTORS
INDICATIONS FOR ECS (%)
Dystocia Malpresentation
Non-
Reassuring
Fetal Tracing
Presence of
Maternal
Illness
Fetal
Anomaly
Others
Repeat
CS (In
Labor)
AGE (YEARS)
<18
18-35
>35

25.0
31.4
29.7

25.0
22.9
24.8

25.0
15.3
8.9

0
5
4

25.0
1.2
1.0

0
7.8
9.9

0
16.5
21.8
GRAVIDITY
1
2
3
4
5
>5

42.4
26.1
19.3
21.9
27.3
9.5

25.4
22.9
6.8
40.6
27.3
42.9

18.8
12.4
9.1
9.4
0
14.3

4.0
3.3
6.8
12.5
0
4.8

1.3
0.7
2.3
0
9.1
0

8.0
5.2
12.5
3.1
0
23.8

0
29.4
43.2
12.5
36.4
4.8
PARITY
1
2-4
>4

41.7
22.0
13.0

26.6
18.5
39.1

17.9
10.6
13.0

4.0
5.5
4.3

1.2
1.6
0

7.9
7.1
21.7

0.8
34.6
8.7
TYPE OF PREVIOUS DELIVERIES
CS
NSVD
Mixed
No previous
deliveries

17.9
28.1
18.5
41.3


8.6
31.6
25.9
27.7

5.7
16.7
11.1
18.6

3.6
5.3
11.1
4.1

0.7
2.6
0
1.2

5.0
14.9
3.7
7

58.6
0.9
8.0
0


19

Similarly, among primiparas, dystocia is the most frequent indication for ECS while in
multiparous repeat CS in labor is the more common indication. Whereas, fetal malpresentation is the
usual indication among grandmultiparas.
A number (41.3%) of parturients were primiparas, thus no previous experience of delivery was
recorded.On the other hand, among parturients who previously delivered via NSVD and mixed (CS and
NSVD) fetal malpresentation is the leading indication while repeat CS is a frequent indication for ECS
among parturients who previously delivered by CS.
Table 9. Maternal Illnesses During Pregnancy and Indications for ECS (N=533).
MATERNAL
ILLNESS
INDICATIONS FOR ECS (%)
TOTAL
Dystocia Malpresentation
Non-
Reassuring
Fetal Tracing
Presence of
Maternal
Illness
Fetal
Anomaly
Others
Repeat
CS (In
Labor)
None 30.3 22.8 14.1 2.9 1.2 8.1 20.7 100
Infectious 44.4 44.4 0 0 0 0 11.1 100
Urinary 32.3 35.5 9.7 0 3.2 6.5 12.9 100
Hypertension 24.2 19.4 19.4 14.5 3.2 8.1 11.3 100
Pulmonary 38.1 28.6 4.8 4.8 0 4.8 19.0 100
Endocrine 42.3 11.5 19.2 3.8 0 7.7 15.4 100
Gynecologic 33.3 20.0 6.7 13.3 0 26.7 0 100
Cardiac 16.7 16.7 33.3 33.3 0 0 0 100
Multi-System 50.0 37.5 0 0 0 12.5 0 100
Others 25.0 25.0 50 0 0 0 0 100

The table above shows that the most common indication for mothers with no health problems is
dystocia (30.3%). The same indication ranked as the most common for parturients with hypertension
(24.2%), pulmonary (38.1%), endocrine (42.3%), gynecologic (33.3%) and multi-system (50%) problems.
For parturients with infectious diseases, dystocia and fetal malpresentation ranked equally as the most
common indication for ECS, each having a percentage of 44.4. For those with urinary problems, fetal
malpresentation (35.5%) ranked as the most common indication and this was followed closely by
dystocia (32.3%). Non-reassuring fetal tracing (33.3%) and presence of maternal illness (33.3%) are the
most common indication for mothers with cardiac problems. For other diseases namely scoliosis,
slipped disk, depression and bipolar I disorder, the common indication for ECS was non-reassuring fetal
tracing.


20

Dystocia (31.6%) was the leading indication for ECS among the parturients who survived ECS.
Among the subjects who died, the indications for ECS were: non-reassuring fetal tracing (66.7%) and
presence of maternal illness, particularly pre-eclampsia (33.3%). Eleven parturients (2.11%) were
discharged against medical advice.

Table 10. Clinical Outcomes of Maternal Subjects According to Indications for ECS (N=533).
INDICATIONS FOR EMERGENCY CS
MATERNAL OUTCOME
SURVIVAL RATE MORTALITY RATE DISCHARGED AGAINST
MEDICAL ADVICE
n % Survived n % Died n % DAMA
Dystocia 160 31.6 0 0 3 27.3
Malpresentation 117 23.1 0 0 4 36.3
Repeat CS in labor 90 17.8 0 0 2 18.2
Non-reassuring fetal tracing 68 13.4 2 66.7 2 18.2
Presence of maternal illness 22 4.3 1 33.3 0 0
Fetal anomaly 7 1.3 0 0 0 0
Others 43 8.5 0 0 0 0




NEONATAL AGE OF GESTATION AND LEADING INDICATIONS FOR ECS

The most frequent indication among pre-term (34.7%) and post-term (62.5%) neonates born
through ECS is fetal malpresentation. In term neonates however, dystocia (39.8%) is the most frequent
reason for conducting ECS (Table 11).

Table 11. Frequency (%) of Indications for ECS as Stratified by AOG (N=534).
INDICATIONS FOR ECS (%)
TOTAL
Dystocia
Malpresentati
on
Non-Reassuring
Fetal Tracing
Presence of
Maternal
Illness
Fetal
Anomaly
Others
Repeat
CS (In
Labor)
AOG (WEEKS)
<28
28-36
37-42
>42

0
10.2
39.8
12.5

0
34.7
19.0
62.5

0
11.9
15.2
12.5

42.9
11.0
2.4
0

0
1.7
1.4
0

57.1
15.3
4.9
0

0
15.3
17.3
12.5

100
100
100
100


21

Dystocia (31.0%) remains the most common indication for ECS among neonates who survived
while non-reassuring fetal tracing (33.3%) is the most common indication for ECS among the neonates
who died. (Table 12)

Table 12. Clinical Outcomes of Neonates According to Indications for ECS (N=534).
INDICATIONS FOR EMERGENCY CS
NEONATAL OUTCOME
SURVIVAL RATE MORTALITY RATE
n % Within
Indication
% of Total n % Within
Indication
% of Total
Dystocia 161 98.2 31.0 3 1.8 20.0
Malpresentation 127 100.0 24.7 0 0.0 0.0
Repeat CS (in labor) 90 97.8 17.3 2 2.2 13.3
Non-reassuring fetal tracing 70 93.3 13.5 5 6.7 33.3
Presence of maternal illness 23 92.0 4.4 2 8.0 13.3
Fetal anomaly 6 85.7 1.2 1 14.3 6.7
Others 41 95.3 7.9 2 4.7 13.3



















22

DISCUSSION

LEADING INDICATIONS FOR EMERGENCY CESAREAN SECTION
This study identifies dystocia as the leading indication for emergency CS. Dystocia is a general
term to encompass the following causes of difficult childbirth: arrest of cervical dilatation, arrest of
descent, cephalopelvic disproportion, failure of descent, midplane contraction, prolonged latent phase,
protracted active phase and failed induction of labor. Among these, arrest of cervical dilatation
emerged as the most common form of dystocia that required ECS.

The identification of dystocia as the leading indication for ECS is supported by other studies. A
sLudy conducLed aL Lhe Cueen MoLher’s PosplLal, Clasgow, found out that dystocia was the main
indication in 16% of cesarean sections performed in 1991. The finding of dystocia in a parturient has,
directly or indirectly, influenced the decision to operate in up to 38% of all cesarean sections that year.
40

However, in a study in Farwani Hospital in Kuwait, failure of descent (33.6%) ranked as the most
common indication for ECS under dystocias. In another study, failure of progress accounted for the
highest number of ECS.
23
A study conducted by Stalberg et al in Sweden documented protracted labor
secondary to a narrow pelvic outlet, as most common indication for ECS.
40
Nonetheless, these earlier
findings support the current finding that dystocia is the leading indication for ECS.

Fetal malpresentation, which includes breech presentation and transverse lie, ranked second as
the most common indication for emergency CS. About 26.6% of the maternal subjects whose babies
were of breech presentation were nulliparous. This finding is supported by the study of Lieberman et al
which noted that nulliparous women are of increased risk of breech presentation.
41


Repeat CS ranked third as the most common indication for ECS (17.3%). Previous studies show
that repeat CS is the leading indication for ECS.
9,10,44
Repeat CS, as one of the indications for ECS,
registers an increasing trend. Its incidence almost doubled, from 3.7% in 1993 to 6.1% in 2002.
43
The
increasing trend for repeat CS may be explained, as in this study, by an early onset of labor prior to the
scheduled operation. Most women in this study presented at the emergency room with uterine
contractions, bleeding and ruptured bag of water. In western countries however, the increasing trend in
repeat CS is due to the option to undergo a trial of labor among women who previously delivered by
cesarean section. Smith et al demonstrated in their study that there is a higher rate of emergency CS
23

(25.4%) in women who underwent a trial of labor after a previous CS delivery compared to women with
no prior cesarean delivery, i.e. nulliparous women (12.5%) and multiparous women who delivered via
vaginal delivery (2.4%).
45
In another study, among 3775 women who had a prior cesarean delivery who
attempted a trial of labor, 1791 (47.2 %) underwent emergency cesarean delivery.
16
The risk of ECS is
9.37 times higher (Adjusted Relative Risk, 95% CI) in women who experienced a trial of labor than those
who did not.

Non-reassuring fetal tracing is the fourth leading indication for ECS. Two studies linked fetal
factor as common indications for ECS. A national cross sectional survey conducted in England and Wales
analyzed 17,780 singleton births (99% of all births)

delivered by emergency cesarean section.

Presumed
fetal compromise, intrauterine growth retardation

or an abnormal cardiogram accounted for 35% of all
emergency CS.
5
According to Bloom et al, emergency cesarean deliveries were performed for
indications such as non-reassuring fetal heart rate, umbilical cord prolapse, placental abruption,
placenta previa with hemorrhage, or uterine rupture.
42



MATERNAL AGE
This study show that majority of maternal subjects (80.3%) belong to the reproductive age
group, 18-35 years old. The high rate of ECS among this age group is expected because majority of
childbirths occur within this age range. Al Nuaim et al. observed the same trend in the rate of
emergency CS in this age group.
23
They noted a higher incidence of emergency CS (79%) in younger age
groups (<35 years) compared with 21% in older patients (>35 years).
25

Almost 1/5 of the parturients who underwent ECS belong to the > 35 yo age group. Several
studies have demonstrated that high incidence of emergency CS is associated with advancing
age.
24,25,26,27,28,29,30,31
This may be due to an increased incidence of placental abruption, placenta previa,
breech presentation, preterm labor, and multiple gestation in parturients of advanced maternal age, not
to mention the presence of chronic diseases associated with advancing age. Advanced maternal age is
also associated with increased incidence of breech presentation.
24,27,32,33

Results of this study show that breech presentation is the second leading indication for ECS
(24.8%) among the > 35 age group. This finding is supported by Dildy et al who reported an incidence of
11% breech presentation in parturients > 45 years of age.
24
This may be due to the tendency of older
24

women to have heavier babies with abnormal presentation. Abu-Heija et al found the same observation
in their study wherein majority of neonates of older women have larger birth weight and of abnormal
presentation compared to those of younger parturients
28
.
Parturients within the < 18 years old age group who delivered through ECS accounted for only
less than 1% of ECS deliveries. These finding may be due to the fewer pregnancies and deliveries in this
age group.
Among 533 patients in the sample population, 507 survived, 3 died and 11 were discharged
against medical advice. The patients who died belong within the 18-35 years age range.

GRAVIDITY
Results of this study show that with increasing gravidity, the frequency of ECS deliveries
decrease. Most of the women who underwent ECS were primigravids. This finding may be explained by
the fact that most primiparas undergo a trial of labor before delivery via cesarean section is entertained.
Cnattingius et al. found in their study that the risk of cesarean delivery is increased among nulliparous
and primigravid (adjusted OR = 4.92, 95% CI = 2.81–8.61), short (adjusted OR = 2.20, 95% CI = 1.06–4.59),
and obese women (adjusted OR = 2.03, 95% CI = 1.07–3.84).
35
This finding supports the study of Patel et
al. which showed that increasing number of gestations was associated with a decreased chances for
CS.
34

Among primigravids, dystocia ranked as the most common indication for ECS, followed by
malpresentation and non-reassuring fetal tracing. As the number of gestations increased from 2 to 3,
repeat CS replaced dystocia as the most frequent indication for ECS. The peak of repeat CS cases is at
the 2
nd
and 3
rd
pregnancies. By the 4
th
pregnancy, a sharp decline is seen which eventually continues
with increasing number of gestations. This finding may be due to the fact that women who underwent
repeated CS limit themselves to 2-3 pregnancies as more pregnancies would increase the risk for CS-
related birth complications such as uterine rupture. With increasing gestations, malpresentation
emerged as a more frequent indication for ECS.
Majority (97.31%) of 521 patients in the sample population survived. Of the 3 patients who
died, 2 were multigravids while the other was a primigravid. Eleven patients discharged against medical
advice were multigravids.
25


PARITY
Results of this study show that with increasing parity, the frequency of ECS deliveries decrease.
This finding agrees with the result of the study done by Al Nuaim et al. where they demonstrated a
statistically significant association between low parity and ECS (P<0.001).
25
Patel et al sealed further the
strong relationship between low parity and emergency CS when they reported that increasing number
of deliveries was associated with a decrease in

risk for both elective and emergency CS.
34

In primiparas, dystocia is the most common indication found while repeat CS is the most
common indication for multiparas. As in gravidity, repeat CS is highest among women who had 2-3
previous deliveries and a sharp decline is observed with increasing parity. Among grandmultiparas, fetal
malpresentation is the most common indication for ECS.
Of the three parturients who died, two were multiparous (2-4 deliveries) and one was
primiparous. No fatality was recorded among grandmultiparous parturients (Appendix A).

TYPE OF PREVIOUS DELIVERIES
Majority of the parturients in the study were primiparas i.e., with no history of childbirth.
Among multiparas, CS (55%) proved to be the most common precedent mode of delivery primarily by
repeat CS. Parturients who delivered under the indication repeat CS were in labor which warranted ECS.
Another possible reason for the high repeat CS rate is Lhe physlclan’s preference in delivering
succeeding pregnancies via CS with a previous CS delivery. This observation is supported by Cnattingius
et al in their case-control study that evaluates the risk factors for ECS, who found out that women with a
previous cesarean delivery had high chances of cesarean delivery (adjusted OR = 10.10, 95% CI = 3.30–
30.92).
35
NSVD (45%) came second to CS as the most common precedent mode of delivery. Most
women in this category had malpresentation and dystocia as the indications for ECS. Multiparas who
previously had delivered via both NSVD and CS had to undergo ECS due to repeat CS and
malpresentation.


26

MATERNAL ILLNESSES
One of the most important risk factors affecting the decision to perform cesarean section is the
presence of maternal illness.
36
Of the 533 subjects, 34.3% presented with illness during the pregnancy.
Most of these women have hypertensive disorders specifically, gestational hypertension, chronic
hypertension and pre-eclampsia. Other disorders present in women who underwent ECS were urinary
problems, followed in descending order by endocrine, pulmonary, gynecologic, infectious, multisystem,
and cardiac diseases.
Hueston

studied the clinical and non-clinical factors associated with increased likelihood of
cesarean delivery in four hospitals. He found out that among the clinical factors, maternal hypertension,
preeclampsia, previous cesarean delivery, premature rupture of membranes, postdate pregnancy and
asthma are associated with increased risk of CS
37
. Moreover, his findings also show that pre-eclampsia
is consistently associated with increased risk of CS. In another study by Omu et al., among women who
underwent emergency cesarean section due to failed induction of labor, most of them are either
postdates or have maternal disorders like diabetes mellitus, and hypertension.
38
Findings of these
studies are consistent with the results of the current study where at least 1/3 of the women who
underwent ECS had an illness with hypertension as the most common co-morbidity.

AGE OF GESTATION
Majority (69.2%) of the ECS deliveries were term. This finding is similar with the retrospective
analysis of 25 consecutive emergency cesarean section for umbilical cord prolapse, which showed that
out of twenty-five, 17 patients were born term (68%).
21

In this study, the percentage of neonates born before term were 21.7% for neonates <37 weeks
and 1.3% for neonates <28 weeks. Hilleman et al reported thirty-three (30.3%) of the emergency
cesarean sections had a gestational age below 32 weeks and 60 (55%) below 37 weeks.
46
Jolly et al
found in their study that parturients of advanced maternal age are more likely to deliver prior to term
and more likely to delivery at < 32 weeks gestation.
27
Pugliese et al. also reported that women > 40
years of age are more likely to deliver preterm (18%) than younger women (12%).
48
The presence of
multiple gestations also contributes to an increased incidence of preterm labor and delivery.
31
However,
in this study even with advanced maternal age, most of the neonates were born term and singly.
27

The mean age of gestation in neonates is 37.8 weeks. In contrast, Hillemann et al. reported the
mean age of gestation in neonates born through emergency CS is at 34.8 weeks.


MATERNAL OUTCOME
Survival rate for ECS is relatively high (97.4%). Some of the reasons cited by The Philippine
Obstetrical and Gynecological Society for the increasing trend of CS in the Philippines are
11
: increasing
safety of the procedure due to antibiotics; availability of blood transfusions; better anesthesia and the
physlclan’s hlgh lntent to deliver a healthy or undamaged baby and leave a healthy mother, when done
for complications occurring during pregnancy and labor; and the relatively newer concept of delivery of
breech by cesarean section intended for better fetal outcome.

Mortality rate was less than 1%. Among the three fatalities, two maternal subjects had non-
reassuring fetal tracing while the other had a medical illness as indications for ECS. Two of the women
who died had chronic hypertension and pre-eclampsia. In a prospective observational study of 8070
elective cesarean sections in Malawi, Africa, pre-eclampsia was cited as one of the complications

believed to contribute to mortality (7, 8% of deaths1).
17
Furthermore, Onrust, in another study, found
that hypertensive disorders of pregnancy are the main cause of maternal mortality in most countries. In
more than half of these cases, the HELLP syndrome is involved.
39


NEONATAL OUTCOME

Based on the data gathered, the success rate in delivering a live neonate by emergency cesarean
section is high (97.2%). This current finding is congruent with the results of the study done by Bloom et
al. which illustrates that most infants delivered by ECS are in good condition when delivered less than or
more than the standard decision-to-incision time (30 minutes from the time the decision is made to
proceed with ECS).
42

A higher mortality rate is recorded among neonates with low (0-3) APGAR scores of at 5 minutes
(88.8%) with its counterpart at 1 minute (9.68%) (Table 6). The same is true in neonates who with
average APGAR scores (4-6 at) 5 minutes wherein 40% died as compared to its counterpart at 1 minute
28

where in 9.7% of the neonates died. This finding signifies that the APGAR score at 5 minutes is a better
predictor for neonatal survival than the APGAR score at 1 minute, as the latter predicts the need for
resuscitation. Survival rates in neonates with APGAR scores 0-3 (37.5%) and 4-6 (90.3%) at 1 minute
decreased to 11.1% and 60%, respectively at 5 minutes. This finding is congruent with the study of Al
Nuaim et al. who found out that neonates born through ECS with an APGAR score of 0-3 at birth had the
highest risk of neonatal death. Furthermore, the risk of neonatal death in term infants was 0.2 per 1000
for those with scores of 0 to 3 at birth.
23

As expected, low mortality rate was seen among neonates with high APGAR scores (7-10) at 1
minute (0.4%) and 5 minutes (5%).


















29

CONCLUSIONS

Majority of the women who delivered via ECS belong to the reproductive age group 18-35 years,
primigravid, primiparous, with no history of co-morbidity. The means of the age, gravidity and parity of
the parturients studied were 29.9 yrs, 2.03, and 1.8, respectively.
Dystocia was the leading indication for ECS among primigravids and primiparous women.
Among multigravid and multiparous women, repeat CS (in labor) was the most frequent indication for
ECS whereas in grandmultiparas, fetal malpresentation was the indication for ECS procedures. Among
parturients with preceding NSVD and mixed deliveries, fetal malpresentation was the typical indication
for ECS.
The occurrence of hypertensive diseases (33.9%) in women with associated morbidities, who
delivered via ECS, was a common finding. Most of these women presented with dystocia which
warranted the conduct of ECS. Among women with urinary problems (16.9%), malpresentation was
the most common indication for ECS while women with endocrine disease (14.2%) underwent ECS
because of dystocia.
The neonates delivered by ECS are mostly term (69.2%) with good APGAR scores of 7-10 (94.4%)
at 1 and 5 minutes. The mean age of gestation of neonates was 37.8 weeks
Dystocia is the leading indication for ECS in term neonates, while fetal malpresentation is the
leading indication for ECS among post-term and pre-term neonates.
The clinical outcome of ECS was favorable for both the mother and the child. Survival was high,
97.4% and 97.2% for both parturients and neonates, respectively. Similarly, mortality rate was less
than 1% for both parturients and neonates. Non-reassuring fetal tracing (66.7 % and 33.3%) was the
most frequent indication for ECS among parturients and neonates who died, respectively.





30

RECOMMENDATIONS

 A multi-center study, involving private and government institutions, may be attempted to
compare the rates and indications for ECS.
 A longer study period may establish patterns in the rate and indications of ECS over the years.
 Variables such as length of hospital confinement, birth complications, anesthesia used, and
prenatal care may also influence the maternal clinical outcomes following ECS.
 Other predictors of neonatal outcome aside from APGAR score such as postpartum hospital stay
and umbilical artery blood pH, may be used to further predict neonatal survival and mortality.
 Future studies should not only look into the leading indications for ECS but also on ways to
decrease the incidence of ECS by modifying the factors associated with ECS.












31

ACKNOWLEDGMENT

The researchers would like to thank Dr. Deb Palmes, their adviser, for the guidance and devotion
poured into this work. Prof. Charmaine Malata for reviewing the manuscript and giving structure to
the paper. Dr. Teila Matilda Posecion for her help in data encoding and analysis. Ma’am Lenny and
Manong Buboy of the Records Section of WVSU-MC for their assistance in data gathering.

















32

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women. Eur J Obstet Gynecol Reprod Biol 1995;61:111-5.
42. Bloom, SL et.al. Decision-to-incision times and maternal and infant outcomes. Obstetrics and
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43. Mikki, Nahed Sabri. et.al.Cesarean delivery rates, determinants and indications in Maqassed
Hospital, Jerusalem, 1993 and 2002. Eastern Mediterranean Health Journal
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Uncomplicated Term Pregnancies. JAMA.2002;287(20):2684-2690.
34

46. Hillemanns, P et al. Crash emergency cesarean section: decision-to-delivery interval under 30 min
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2005 273(3).
47. Hillemanns, P et al. Maternal and neonatal morbidity of emergency caesarean sections with a
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48. Hoyert DL, et al. Maternal Mortality, United States and Canada, 1982-1997. Birth 2000; 27: 4-11.









































35

APPENDIX A
INVESTIGATORS’ BIODATA

Name: MA. ROWENA H. ALCIDO
Age: 24 Birthdate: Nov. 15, 1984

City Address: 36-A DB Ledesma St., Jaro, Iloilo City
Permanent Address: 353 San Fernando St., Borongan City
Contact No: 09274813769
E-mail Address: rowena_alcido@yahoo.com

Undergraduate Course: BS Biology Major in Cell & Molecular Biology
Undergraduate School: University of the Philippines – Los Baños

Research Experiences:
1. Effect of Chlorella sp. on Length and Weight of Male Albino Rats (Rattus norvegicus Sprghe-Dahly)
2. Screening of E. coli in Selected Water sources in West Visayas State University
3. Antimitotic Properties of Crude and Commercial Mangosteen (G. magostuna) Extracts in Onion
(Allium cepa)






Name: DENNIS F. ARANDA
Age: 23 Birthdate: Nov. 14 , 1984

City Address: 36-A DB Ledesma St., Jaro, Iloilo City
Permanent Address: #45 Rizal St., Oton, Iloilo
Contact No: 09158599341
E-mail Address: densaranda2003@yahoo.com

Undergraduate Course: BS Medical Technology
Undergraduate School: University of San Agustin

Research Experiences:
1. Awarenss on the Sources and Effects of Trans Fatty Acids and the Extent of Preventive Practice among
Faculty and Staff of West Visayas State University
2. Effects of Combined Lotus Leaf, Ginseng, Hawthorn, Medlar and Polyphenol in Commercially-Available
Slimming Pills (Ballerina) on SGPT and Creatinine levels in Rabbits




36


Name: VANESSA DOLENDO
Age: 24 Birthdate: July 16, 1984

Permanent Address: 276 B. Javellana Ext., Jaro, Iloilo City
Contact No: 09172430429
E-mail Address: van016_bunny@yahoo.com.ph

Undergraduate Course: BS Biology
Undergraduate School: West Visayas State University

Research Experiences:

1. Knowledge, Awareness, and Perception of Barangay Captains on the Anti-Violence Against
Women and Their Children (RA9262)
2. Isolation and Characterization of Cytotoxic Protein from the Summer Jellyfish (Cassiopea
medusae)








Name: REUBEN V. HINOJALES
Age: 27 Birthdate: July 6, 1981

City Address: Sta. Rosa Subdivision, Tagbak, Jaro, Iloilo City
Contact No: 09064670055
E-mail Address: Kilz2@yahoo.com

Undergraduate Course: BS Biology
Undergraduate School: La Sierra University – California, USA

Research Experiences:
1. Awareness on the Risk of Cervical Cancer among Commercial Sex Workers
2. Effect of Prolonged Intake of Virgin Coconut Oil in Total Cholesterol (T chol); Low Density Lipoprotein
(LuL) and Plgh uenslLy LlpoproLeln (PuL) levels of LaboraLory 8abblLs ln Comparlson wlLh a α-
tocopherol: A Placebo Controlled Trial








37

Name: NORIE GRACE D. OMAMALIN
Age: 26 Birthdate: July 16, 1982

City Address: Door 4, Javelosa Apts., Javellana St., Jaro, Iloilo City
Permanent Address: Sta. Clara, Naga, Zamboanga Sibugay Province
Contact No: 0922-2463921
E-mail Address: ndomamalin@yahoo.com

Undergraduate Course: BA Political Science
Undergraduate School: University of the Philippines – Diliman

Research Experiences:
1. Degree of Fecal Contamination of the Three Point Sources in the Southern Iloilo Coastline In Relation
to the Incidence of Health Risks
2. Efficacy of Pure and Combined Extracts of Lantana camara (Baho-Baho) Flowers and Leaves and
Citrofortunella mitis (Calamansi) peel as an Adulticidal Spray against Aedes aegypti








Name: MARY-GRACE A. ORDONA
Age: 23 Birthdate: June 23, 1985

ClLy Address: 3M’s AparLmenL, 8. Mapa “L., Mandurrlao, llollo ClLy
Contact No: 09208023817
E-mail Address: mergs_23@yahoo.com

Undergraduate Course: BS Public Health
Undergraduate School: University of the Philippines – Miag-ao

Research Experiences:
1. Awareness on the Risk of Cervical Cancer among Commercial Sex Workers
2. Effect of Prolonged Intake of Virgin Coconut Oil in Total Cholesterol (T chol); Low Density Lipoprotein
(LDL) and High Density Lipoproteln (PuL) levels of LaboraLory 8abblLs ln Comparlson wlLh a α-
tocopherol: A Placebo Controlled Trial









38

Name: REDAN MARK PANELO
Age: 23 Birthdate: April 11, 1985

Permanent Address: Block 8 Lot 13 Imperial Village, Guzman St., Mandurriao, Iloilo City
Contact Number: 0920-3893565
Email: redanmark@yahoo.com

Undergraduate Course: BS Biology
Undergraduate School: West Visayas State University

Research Experience:

Antihyperglycemic Effect of Psyzigium Cuminii Bark and Seeds on Mice









Name: JULYHA SITTI SUIB
Age: 23 Birthdate: July 4, 1985

Permanent Address: Block 10 Lot 19 Gensanville Subd., Gen. Santos City
Contact Number: 0916-4968226
Email: july_0704@yahoo.com

Undergraduate Course: BS Biology, Major: Ecology
Undergraduate School: UP-Mindanao


Research Experiences:

1. Reactions of Different Durian Cultivars to Phytophthra Fruit Rot Under Controlled Conditions
2. Level of Awareness, Knowledge, and Attitude of Mothers in Iloilo City to Sangkap Pinoy Program