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Cesarean section: changing incidence and indications.

L C Gilstrap, J C Hauth, S Toussaint

    Obstetrics and Gynecology
    |February 1, 1984
    PubMed
    Summary
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    Cesarean section rates fluctuated significantly between 1970-1981, initially rising due to dystocia, breech presentation, and fetal distress, then declining after interventions were implemented to reduce the cesarean rate.

    Area of Science:

    • Obstetrics and Gynecology
    • Maternal-Fetal Medicine
    • Public Health

    Background:

    • Cesarean section rates have been a significant concern in obstetric practice.
    • Understanding trends and indications for cesarean delivery is crucial for improving maternal and infant outcomes.

    Purpose of the Study:

    • To analyze trends in primary and repeat cesarean section rates.
    • To identify changes in the indications for cesarean delivery over time.
    • To evaluate the impact of interventions aimed at reducing cesarean rates.

    Main Methods:

    • Retrospective analysis of 19,419 deliveries at Wilford Hall USAF Medical Center from 1970-1981.
    • Categorization of cesarean sections into primary and repeat operations.
    • Examination of common indications: dystocia, breech presentation, repeat operation, and fetal distress.

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  • Statistical analysis of trends across three distinct time periods (1970-1973, 1974-1977, 1978-1981).

    • Main Results:

    • The primary cesarean section rate increased from 5.6% (1970-1973) to 12.8% (1974-1977), driven by dystocia, breech presentation, and fetal distress.
    • The primary cesarean section rate subsequently decreased to 9.6% (1978-1981) (P < .0001).
    • This decrease was associated with significant reductions in rates of dystocia and fetal distress, coinciding with efforts to lower the overall cesarean rate.

    Conclusions:

    • Cesarean section rates are dynamic and influenced by clinical practice and targeted interventions.
    • The study highlights the effectiveness of specific strategies in mitigating rising cesarean delivery rates.
    • Continued monitoring and evaluation of cesarean section trends and indications are essential for optimal obstetric care.