Cesarean section in postdated pregnancies: Evidence from a hospital-based cross-sectional study in Bangladesh

Background: Postdated pregnancies pose maternal and fetal risks, often leading to increased rates of cesarean section (CS).  Cesarean sections are performed without medical necessity in some cases, thereby increasing both risks and healthcare costs. The study aimed to assess the indications and fetomaternal outcomes of CS in postdated pregnancies.
Methodology: This cross-sectional study was carried out at a specialized hospital in Dhaka. It analyzed 59 postdated pregnancies undergoing cesarean section from May to December 2020. Fetomaternal characteristics and outcomes were descriptively analyzed, and cases were also categorized using the Robson Classification and analyzed descriptively to understand cesarean section rates among different obstetric groups and to identify intervention areas.
Results: Most women were 20–30 years old (72.9%), with 22% exceeding 42 weeks gestation. 72% of postdated primigravida had CS, comprising 64.4% of all cases. Half of the women received antenatal care (ANC) irregularly. Maternal outcomes were mostly uneventful (83%); while 17% experienced postpartum hemorrhage. Of the babies, 15.3% had low birth weight (<2.5 kg), and 23.7% had low APGAR scores at 1 minute. Major CS indications included fetal distress (67.8%), failed induction (16.9%), and failure to labour progress  (15.3%). The Robson Classification system found Group 2 accounted for 64% of all CSs. Higher cesarean section rates were also observed within various groups, particularly in Groups 5 and 6.
Conclusion: This study found a higher cesarean section rate among postdated primigravida, with fetal distress being the most common indication. Using the Robson classification could reduce unnecessary cesarean deliveries in this group.