CESARIAN SECTION - HIGHER RATE AND HIGHER CHALLENGES

There is evidence that perinatal morbidity and mortality has not changed - caesarean section rate increased and data remained stable and rate of intro and post operative complications was increased. There is another view of the picture: the right of patient to choose mode of delivery and the reality, that the number of patients with prior caesarian section and number patient and physician prefer caesarean section. The following topics are discussed as well: age of pregnant woman, macrosomia and intrauterine growth restriction, malpresentation, multiple gestation, preeclampsia, BMI, role of assisted reproductive technologies, electronic monitoring of fetal heart rate in labor, induction of labor. Private sector role and physicians fear of legal issues are also addressed. Postoperative complications are discussed and authors conclude that it is associated with non rational rate of caesarian section. The health sector authorities and physicians must carefully choose the mode of delivery especially in primagravidas.