Is the epidemic of cesarean sections the result of more liberal indications?

Abstract

Introduction: The rate of cesarean sections around the world is steadily rising. The analysis of indications for cesarean section might fi nd the answer to the question whether this trend is a consequence of more liberal indications. Objectives: The aim of the study was to analyze and compare the changes in the indications for cesarean sections (cs) over the years. Material and methods: Data regarding cesarean sections performed at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, were analyzed and compared: 559 cs between the years 2000-2001 (G1) and 663 cs in 2010 (G2). Results: The rate of cs was statistically higher in 2010 (30.1% vs. 29.2%; p<0.001), however the rate of preterm cs was lower (25.4% vs. 11.9%; p<0.01). The most frequent indication for cs in 2010 was lack of patient consent for vaginal birth after cs (27.3% vs. 17.9%; p<0.01). Other frequent indications throughout the decade were: fetal distress (G1 18.6% vs. G2 14.2%; p<0.01), cervical dystocia (12.3% vs. 11%, respectively), fetal position other thancephalic (12.5% vs. 13.6%) and non-obstetrical indications (14.1% vs. 9.4%; p<0.05). Conclusions: In the last decade the rate of cesarean sections has risen and there are minor diff erences in the indications for cs. Previous cesareans delivery seems to be the main cause of an increase in the number of cs nowadays.