The changing trend in the rate of caesarean section at a teaching hospital

This is a retrospective study analysing the reasons behind the observed increasing rate of caesarean section (C/S) over a 10-year period (1990-99) in the obstetric unit of Jordan University Hospital. All the indications of C/S carried out in the unit were analysed. The duration of the study was divided into 2, of 5 years each (1990-94, 1995-99). There was a 6.9% increase in the C/S rate over the second half of the study period. This was statistically significant (P < 0.001). All the indications contributed significantly to rise. Fetal distress had the highest contribution 33.5%, while repeat C/S and malpresentation contributed to 21.5% and 21.3%, respectively. This increase was not associated with a significant change in the perinatal mortality. The rise in the caesarean section rate was higher in primigravida compared with multigravida (10.9% vs 6.2%). Fetal distress has the highest contribution in primigravida. In multigravida, if we exclude repeat caesarean section, the major indications were fetal distress and malpresentation. The percentage of elective and emergency caesarean section was similar in both study periods. The reasons behind the increase C/S rate couldn't be understood. Probably a lower threshold concerning the decision to perform the C/S rather than a change in obstetric management in responsible for this rise.