Are cesarean delivery rates and indications changing?




Cesarean section indication, Cesarean section rate, Failed induction, Foetal distress, Repeat Cesarean section


Background: There seems to be gradual raising trend in cesarean deliveries over decades with associated decrease in perinatal mortality rate. This study was undertaken to compare the caesarean delivery (CS) rates along with its indications over the last decade and to examine whether it is changing.

Methods: The aim is to compare the rate and indications of CS in a retrospective manner from the data collected between January 1 and December 31 in the year 2006, 2011, and 2016 in a zonal hospital. The rates and indications of CS were analyzed to find whether they are changing if yes which are the factors contributing for the same. Categorical variables were compared using chi-square test.

Results: The CS rate showed an increasing trend from 26 % in 2006 to 27.6 % in 2011 to 32.4 % in 2016. Of the total CS, repeat CS rate was significantly increased from 76 (6.61%) in 2006 to 106 (10.34%) in 2011 to 128 (13.72%). Primary CS percent remained more or less same during the study period. Post cesarean pregnancy (p=0.00001) and fetal distress (p=0.012) showed significant rise as an indication for CS which were major contributor for rise in last decade while failed induction decreased.

Conclusions: Over the decade there is increase in the total CS rate mainly attributable to repeat CS while post CS pregnancies and foetal distress were leading cause for CS. There is need for reducing primary CS along with increase in trial of labor after cesarean in properly selected women.


Turner MJ. Delivery after one previous cesarean section. Am J Obstet Gynecol.1997;176(4):741-4.

Oladapo OT, Sotunsu JO, Sule-Odu AO. The rise in caesarean birth rate in Sagamu, Nigeria: reflection of changes in obstetrics practice. J Obstet Gynaecol. 2004;24:377-81.

Tollånes MC. Increased rate of Caesarean sections-causes and consequences. J Norwegian Med Ass: J Practical Med, New Series. 2009;129(13):1329-31.

Belizán JM, Showalter E, Castro A, Bastian H, Althabe F, Barros FC, et al. Rates and implications of caesarean sections in Latin America: Ecological study Commentary: all women should have a choice Commentary: increase in caesarean sections may reflect medical control not women's choice Commentary: “health has become secondary to a sexually attractive body”. BMJ. 1999;319(7222):1397-402.

World Health Organization. Monitoring emergency obstetric care: a handbook. Geneva, Switzerland. 2009.

Agarwal M, Verma M, Garg A. Changing trends in cesarean delivery: rate and indications. Int J Reprod Contracept Obstet Gynecol. 2016;5(10):3522-4.

American College of Obstetricians and Gynecologists. Vaginal birth after previous cesarean delivery. Practice bulletin; no. 115. Washington, DC: ACOG; 2010.

Barber EL, Lundsberg L, Belanger K, Pettker CM, Funai EF, Illuzzi JL. Contributing indications to the rising cesarean delivery rate. Obstet Gynecol. 2011;118(1):29.

Mittal S, Pardeshi S, Mayadeo N, Mane J. Trends in Cesarean Delivery: Rate and Indications. J Obstet Gynaecol India. 2014;64(4):251-4.

Ba'aqeel HS. Cesarean delivery rates in Saudi Arabia: a ten-year review. Annals Saudi Med. 2009;29(3):179.

Das S, Char D, Sarkar S, Saha TK. Changing trends in caesarean section: rate and indications. J Dental Med Sci. 2014;13(1):7-9.

Agarwal M, Verma M, Garg A. Changing trends in cesarean delivery: rate and indications. Int J Reprod Contracept Obstet Gynecol. 2016; 5:3522-4.

Stavrou EP, Ford JB, Shand AW, Morris JM, Roberts CL. Epidemiology and trends for Caesarean section births in New South Wales, Australia: a population-based study. BMC Preg Childbirth. 2011;20(11):8.

Chong C, Su LL, Biswas A. Changing trends of cesarean section births by the Robson Ten Group Classification in a tertiary teaching hospital. Acta Obstet Gynecol Scand. 2012;91(12):1422-7.

Litorp H, Kidanto HL, Nystrom L, Darj E, Essén B. Increasing caesarean section rates among low-risk groups: a panel study classifying deliveries according to Robson at a university hospital in Tanzania. BMC Preg Childbirth. 2013;8(13):107.

Choudhary AP, Dawson AJ. Trends in indications for caesarean sections over 7 years in a Welsh district general hospital. J Obstet Gynaecol. 2009;29(8):714-7.

Liu S, Rusen ID, Joseph KS, Liston R, Kramer MS, Wen SW, et al. Recent trends in caesarean delivery rates and indications for caesarean delivery in Canada. J Obstet Gynaecol Can. 2004;26(8):735-42.

Krychowska A, Kosin´ska K, Karwan-Płon´ska A. Comparison of indications for caesarean section in 1985-86 and 2000-01: analysis of changes. Ginekol Pol. 2004;75(12):926-31.

Hofmeyr GJ, Gülmezoglu AM, Pileggi C. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database of Systematic Reviews 2010, Issue 10. Art. No.: CD000941.

Delaney S, Shaffer BL, Cheng YW, Vargas J, Sparks TN, Paul K, et al. Labor induction with a Foley balloon inflated to 30 mL compared with 60 mL: a randomized controlled trial. Obstet Gynecol 2010;115:1239-45.






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