Is a rising caesarean section rate inevitable?

Abstract

Objective To determine the indications for singleton caesarean sections in Scotland in 1994.Design Prospective survey of singleton caesarean sections using information provided by clinicians Setting Twenty-three consultant-led obstetric units in Scotland.Population Women undergoing caesarean section in participating Scottish maternity units during 1994.Results Using routinely collected data it was found that the caesarean section rate varied by maternal age, parity, gestation, history of previous section and hospital of delivery, but there was no difference by area of deprivation. 87.4% (836919573) of Scottish caesarean sections were included in the survey of which 8098 were in women with singleton pregnancies. Most singleton caesarean sections were undertaken in primiparae (50*5%), 3 1.2% were in women with a history of previous section and 18.3% were in multiparous women who had not had a previous section; 38.9% of the operations were elective, 13.9% were emergencies before labour and 47.2% were emergencies during labour. Four main indications-elective section for breech presentation (10.7% of all sections); emergency caesarean section before labour because of fetal problems (2.8%); emergency caesarean section during labour for fetal distress andor failure to progress (30.3%); repeat section for reasons other than above (1 6.2%) accounted for 60% of all Caesarean sections in women with no other recorded complications. 7.7% of all singleton caesarean sections (19.8% of elective operations) were associated with maternal request for the operation.Discussion The survey has identified why caesarean sections are performed by Scottish obstetricians and highlighted some areas where there would be scope to increase the vaginal delivery rate. Before this can be attempted, agreement must be reached by clinicians about effective management of particular problems. Women also need to have ready access to evidenced-based information about caesarean section.entering data onto a computer in labour wards.

Pregnancy and Delivery in Women with Uterine Malformations

“…During the last 40 years, the caesarean section rate increased significantly from 5% in the 70s, to over 50% in the 90s. The highest rates of caesarean section were observed in Italy (39%), Portugal (25%) and Switzerland (32%) [17,18]. In 1995, the rate of cesarean deliveries in the United States was 21%, while in 2007 it increased up to 31.8% [19,20].…”

Conduta Obstétrica na Apresentação Pélvica

“…Estudo escocês mostrou que as principais indicações de cesárea em mulheres com apresentação pélvica foram a nuliparidade, cesárea prévia e multiparidade 10 . Não existem, contudo, evidências científicas concretas que suportem esta conduta.…”

Caesarean Section the Rising Trend: A Retrospective Study

“…20 Improved surgical techniques, availability of broad-spectrum antibiotics, blood transfusion facilities, intensive care units have made CS a safe procedure and there are maternal demands for CS of 23 to 38.9%, which has increased the incidence of CS. 21 It is reported that VBAC trials with proper selection criteria and proper monitoring protocols can help in reducing the rate of CS. 18,19 In our study the second largest contributor to the primary CS rate was foetal distress, 16% similar to other reports.…”