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Top1. Introduction
Cesarean section is the first major operation to prevent childbirth complications from high-risk pregnancy (Khunpradit et al., 2005; Wianwiset, 2011). The proportion of child births carried out with Cesarean section continuously increased worldwide. Cesarean sections (CS) rates continue to increase worldwide without a clear understanding of the main drivers and consequences. The lack of a standardized internationally-accepted classification system to monitor and compare CS rates is one of the barriers to a better understanding of this trend (Betrán AP et el.,2014). The World Health Organization recommends a C-section rate of between 10% and 15% (Boris Milovic et al., 2012) of all births per country. Since the current C-section rate in Bangladesh is 31%, a minimum excess (unnecessary C-sections) of 8% exists if we use the conservative end (15%) of the WHO range. Number of medically unnecessary C-sections - between 2016 and 2018 the number of operations increased by 51 per cent (savethechildren, 2020). This paper discusses how to reduce the cesarean rate by analyzing the causes of Caesar by surveying pregnant mothers in different countries including Bangladesh. Most of them are on the continent of Asia. Individual clinical conditions for indication of C-section are grouped into 10 sub classes: hypertensive disorder, mal presentation, disorder of amniotic fluid, antepartum haemorrhage (APH) including placenta praevia, post-dated pregnancy, prolonged & obstructed labour, fetal distress, previous cesarean delivery, maternal disorder related to pregnancy, and general disease complicating pregnancy. The fetal distress group includes non-specified fetal distress and fetal distress due to meconium-stained liquor. Hypertensive disorder covers gestational hypertension, pre-eclamptic toxaemia (PET) and eclampsia. Amniotic fluid disorder category includes oligo and poly-hydramnion. However, cephalo-pelvic disproportion (CPD) and failed induction of labor are included in the category of prolonged or obstructed labor. Finally, C-section indications documented as Maternal distress, Rh negative mothers and retention of urine were grouped under ‘pregnancy-related maternal disorder’, while thalassemia, anemia, asthma belong to ‘general disease complicating pregnancy’ category. Later on, C-section indication documented under APH including placenta Previa’ ‘pregnancy-related maternal disorder’ and ‘general disease complicating pregnancy’ were re-categorized under ‘other indications (Khunpradit et al., 2005; Wianwiset, 2011;Betrán AP et al.,2014;Kavitha et al.,2018; Tamala Gondwe et al., 2019; Stephen J.Robson et al., 2017; Samiran Bisai, 2010;webmd,2020;Suwarno, 2019).
Figure 1. Distribution of C-section indications by three different categories .CS for AMI (Acute myocardial infarction )(Yes & No); Repeat CS (Yes & No); Underlying cause (Fetal, Maternal & combined).
Thus, based on logistics and medical parameters, choosing the best method is important in successful completion of the pregnancy (Kavitha et al.,2018). This paper has looked into the reason of cesarean of both elective and emergency cesarean section. During the entire period of nine months, reports of obstetric ultrasonography, blood and urine tests conducted periodically yield a lot of data. Use of appropriate cleaning, sorting and classification techniques reveals patterns which can predict possible threats or anomalies. (Betrán AP et al.,2014;Kavitha et al.,2018; Tamala Gondwe et al., 2019; Stephen J.Robson et al., 2017; Samiran Bisai, 2010).