EXPLORING THE INTERPLAY OF CESAREAN SECTION RATES, RISK FACTORS, AND CT PELVIMETRY IN THE THIRD TRIMESTER OF PREGNANCY A STUDY AT KHYBER TEACHING HOSPITAL PESHAWAR PAKISTAN

Abstract

Background: Childbirth is a complex physiological process that may be complicated by cephalopelvic disproportion and other maternal or fetal factors, leading to cesarean section (CS). Obstetric pelvimetry, including CT-based assessments, plays a crucial role in evaluating pelvic capacity and predicting delivery outcomes. Rising CS rates globally and regionally necessitate better understanding of demographic, socioeconomic, and anatomical factors influencing delivery choices, particularly in resource-limited settings.

Objective: The study aimed to evaluate demographic, socioeconomic, and pelvic characteristics associated with cesarean section deliveries using CT pelvimetry among women in Peshawar, Pakistan.

Methods: This cross-sectional study was conducted in the Radiology Department of Khyber Teaching Hospital, Peshawar, from January 1, 2021, to December 31, 2022. A total of 71 women aged 17–40 years who underwent CT pelvimetry before delivery and delivered through CS were included. Women with significant comorbidities or deformities were excluded. Data were collected through structured questionnaires covering maternal age, height, weight, nutritional status, educational and professional background, socioeconomic status, husband’s occupation, obstetric history, and CT pelvimetry parameters. Fetal characteristics such as presentation and number of fetuses were also recorded. Data were analyzed using SPSS version 25, with results expressed as frequencies and percentages.

Results: Among the 71 patients, 77.4% were between 21–30 years, 18.3% were under 20 years, and 4.2% were above 30 years. A majority (71.8%) had below-average height, while 84.5% had average weight. Only 21.9% were educated, and 78.1% were uneducated. Most belonged to middle-class families (80%), 74.6% had husbands working as laborers, and 94.3% were housewives. More than half (53.3%) had undergone previous CS. Indications included cephalopelvic disproportion (69%), fetal distress (22%), and cord around the neck (7%). Fetal presentations were predominantly cephalic (94.3%), with 98.6% singleton pregnancies. CT pelvimetry revealed abnormalities in outlet anteroposterior diameter in 97%, mid-cavity anteroposterior diameter in 60%, greater transverse diameter in 57%, and interspinous diameter in 54%. Urban women accounted for 76% of CS deliveries compared to 23.9% from rural areas.

Conclusion: The study highlighted that demographic, socioeconomic, and pelvic parameters significantly influence CS deliveries, with cephalopelvic disproportion being the leading indication. Strengthening maternal education, addressing healthcare disparities, and using CT pelvimetry as a predictive tool may help reduce unnecessary surgical interventions and improve obstetric outcomes.