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Rising Cesarean Rates: Are Primary Sections Overused?

Kalpana Mahadik1

  • 1Department of Obstetrics and Gynaecology, R. D. Gardi Medical College, Ujjain, 456006 India.

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|December 18, 2019
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Global cesarean delivery rates doubled between 2000 and 2015, raising concerns of overuse. Strategies focusing on optimizing primary cesarean indications and using classification systems can help reduce these rising rates.

Keywords:
Labor dystociaModifiable indications of cesareanPrimary cesareanRising cesarean ratesRobson classification

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Area of Science:

  • Obstetrics and Gynecology
  • Global Health

Background:

  • Cesarean section (C-section) rates globally doubled from 2000 to 2015.
  • This rapid increase occurred without a corresponding decrease in maternal or neonatal morbidity/mortality, suggesting potential overuse.

Purpose of the Study:

  • To review the reasons behind the exponential rise in C-section rates.
  • To explore strategies for reducing C-section rates globally.

Main Methods:

  • Literature search focusing on evidence from the last 5 years.
  • Analysis of modifiable indications for primary C-sections.
  • Review of global C-section rate data and contributing factors.

Main Results:

  • Previous C-sections are a major contributor to rising rates.
  • Modifiable indications include labor dystocia, non-reassuring fetal heart rate tracing, suspected fetal macrosomia, malposition, risk-adapted obstetrics, elective C-sections, and labor induction overuse.
  • Uniform classification systems (Robson/WHO) and audits are key.

Conclusions:

  • Optimizing indications for primary C-sections is crucial.
  • Implementing standardized classification systems, WHO/FIGO recommendations, and audits can help control C-section rates, particularly in nulliparous women.