Changing rates and indications for cesarean sections at a community hospital from 1972 to 1979

The indications for all cesarean sections done at Charleston Area Medical Center from 1972 to 1979 were reviewed. The cesarean section rate rose from 4.4% in 1972 to 8.8% in 1975, to 17.2% in 1979. Repeat cesarean sections accounted for 30.3% of all cesarean sections. The increase in the rate of primary cesarean sections was due to more cesarean sections being done for old indications as well as for the additional indications. From 1972 to 1979, cesarean sections performed for indication of dystocia increased threefold, for fetal distress ninefold, and for breech presentation elevenfold. Dystocia, however, remained the leading indication for primary cesarean section. Even though more cesarean sections and fetal surveillance tests were done from 1976 to 1979 than from 1972 to 1975, the perinatal mortality rate during the two four-year periods was not significantly different. Recommendations are made to a more objective and rational evaluation of the need to perform cesarean sections and for a periodic audit of both the operation and cost-effectiveness of the newer technology.