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13.06.2019 | Review Article | Ausgabe 6/2019

The Journal of Obstetrics and Gynecology of India 6/2019

Rising Cesarean Rates: Are Primary Sections Overused?

The Journal of Obstetrics and Gynecology of India > Ausgabe 6/2019
Kalpana Mahadik
Wichtige Hinweise
Kalpana Mahadik, Professor, Department of Obstetrics and Gynaecology, at R. D. Gardi Medical College, Ujjain, India.

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Doubling of C-section rates from year 2000 to 2015 globally was declared an eye-opener on October 13, 2018, in FIGO World Congress. Rapid increase in rates without clear evidence of concomitant decrease in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. This review addresses issues related to exponentially rising rates, reasons for it, and strategies to reduce. Previous cesarean delivery has main contribution to rising rates as per evidence from the literature search in last 5 years. Focus on optimizing indications of primary C-section resulted in making us rethink modifiable indications like labor dystocia, indeterminate fetal heart rate tracing, suspected fetal macrosomia, malposition, risk-adapted obstetrics, litigation fears, on demand cesarean in literate women and overuse of labor induction. Use of uniform classification system (Robson/WHO classification) with recommendations of WHO, FIGO and annual audits with cloud-based anonymous registry will streamline decisions for cesarean in nullipara and help to control the situation.

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