THE RISE IN CESAREAN-SECTION RATE - THE SAME INDICATIONS BUT A LOWER THRESHOLD

Objective To investigate the reasons for the rise in caesarean section rate and note any change in indications. Design A retrospective, desc riptive study comparing the years 1962 and 1992. Setting A large city centre teaching hospital. Results There was an overall increase in the caesarean section rate from 6.8% in 1962 to 18.1% in 1992. No single cause contributed more than 30% towards this increase. The main indica tions in both years were similar: failure to progress (42.2% vs 36.7%) and fetal indications (18.1% vs 18.9%). The largest relative increase s were in the malpresentation group (10.8% vs 16%) and previous caesar ean section(45% vs 15.2%). Conclusions These results suggest that ther e has been a lowering in the overall threshold concerning the decision to carry out a caesarean section rather than changes in obstetric man agement. Obstetricians and the women in their care have to decide whet her the current balance between risk and benefit is acceptable or whet her they wish to alter the underlying philosophy if any significant re duction is to be sustained.