[Epidemiology of Cesarean section and birth surveillance]

The authors studied the incidence and the determinants of cesarean section in ASL Naples 4. In addition while they analysed the reliability and completeness of birth certificates in order to verify their accuracy for statistical and epidemiological purposes. The results show an increase of cesarean section higher than national mean (from 1997 to 2000: 44.5-54.9%), rarely justified by real risk conditions. 41.1% of vertex deliveries required cesarean section. The most frequent indications were repeated cesarean section (40.6%) and fetal problems (39.3%) in the multiparous; fetal dystocia (27.8%) and fetal distress (17.1%) in the primiparous. The quality of the compilation of the certificates was unsatisfactory for completeness and reliability. Indeed, 14.9% of 1997 birth certificates and more than 70% in the following years did not reach the epidemiological services of ASL; moreover, the comparison with clinical records proved that 46.9% of presentations resulted abnormal on clinical records were vertex on the birth certificates.