Indications and Outcomes of Emergency and Elective Cesarean Section Deliveries in a Tertiary Care Hospital in Karachi, Pakistan: A Retrospective Study

Background: This study identified major determinants of Cesarean-sections and the outcomes in one referral center. Methods: A retrospective study was conducted at a tertiary healthcare facility and all women who had cesarean section between January 2020 to July 2021 were enrolled. A chi-square or independent t-test was used to compare maternal and pregnancy characteristics, and neonatal outcomes between emergency c-sections (EmCS) and elective c-sections (ElCS) groups. A multivariable logistic regression analysis compared indications and outcomes between the two groups. Results: Among 767 women, there were 417 (54.4%) emergency and 350 (45.6%) elective cesarean sections. A multivariable logistic regression revealed that the odds of emergency c-sections were higher among women who were < 25 years (OR: 2.04; CI: 1.11, 3.76), had no previous cesarean section (OR: 4.24; CI: 1.96, 9.16), were primigravida (OR: 2.76; CI: 1.14, 6.67), and had fetal complications (OR: 3.56; CI: 2.29, 5.54). The odds of transferring to the higher care unit were 5.42 times higher (CI: 1.54, 19.08) in the emergency group compared to the elective group. Similarly, neonates of the emergency C-section group had two times higher odds of being admitted to the neonatal intensive care unit (OR: 4.39; CI: 2.16, 8.91) than in the elective group. Conclusions: Emergency cesarean sections were higher among young women with primigravida and those who had a risk of fetal complications. The maternal and neonatal complications were higher in the emergency than the elective C-section group.