INDICATIONS FOR CESAREAN-SECTION IN SINGLETON PREGNANCIES IN 2 DANISHCOUNTIES WITH DIFFERENT CESAREAN-SECTION RATES

Objective. To compare the clinical indications for delivery by cesarea n section (CS) in singleton pregnancies in two Danish counties with di fferent CS rates, and to describe the relation between CS in the two c ounties and parity, mother's age, type of delivery department, gestati onal age at birth, and birthweight. Design. A population-based, follow -up study based on antecedent data. Setting. Two Danish counties, wher e women deliver in obstetric as well as surgical departments, with a C S rate of 8.3% and 15.2%, respectively. Subjects. All pregnant women i n the two counties who delivered in 1989. Main outcome measures. Compa rison of the rates of CS in the two counties carried out for five well -defined clinical indications: Previous cesarean section, breech prese ntation, dystocia, fetal distress, and other. Secondary measures. Neon atal and maternal outcomes. Results. In the county with the higher fre quency of CS, all indications for CS were used significantly more ofte n, except from 'fetal distress' in primiparous women. In this county ' breech presentation' was the commonest indication among primiparous wo men, whereas 'fetal distress' was the most common in the county with t he lower CS rate. For multiparous women the highest CS rates in both c ounties were found among women who had had a previous CS. The major di fference between the two counties was the threefold greater risk of CS indicated by 'dystocia' among multiparous women in the county with th e higher CS rate. Conclusion. The regional differences in CS could not be explained by differences between the two populations or by an incr eased rate of a single indication, but could be due to differences in obstetric practice or expectations or demands from the pregnant women.