title: Trends in the modes of delivery and their impact on perinatal mortality rates.
abstract: OBJECTIVE
  To determine changes in the incidence of vaginal deliveries, cesarean sections, and forceps deliveries and their potential association with fetal, early neonatal, and perinatal mortality rates over time.
  
  
  METHODS
  A retrospective study was carried out and the occurrence of deliveries supervised by university services between January 1991 and December 2000 was determined. Data regarding fetal, early neonatal, and perinatal deaths were assessed using obstetric and pediatric records and autopsy reports.
  
  
  RESULTS
  Of a total of 33,360 deliveries, the incidence of vaginal deliveries, cesarean sections, and forceps deliveries was relatively steady (around 60, 30, and 10%, respectively) while, at the same time, there was a marked reduction in fetal mortality (from 33.3 to 13.0 per thousand), early neonatal mortality (from 30.6 to 9.0 per thousand), and perinatal mortality (from 56.4 to 19.3 per thousand).
  
  
  CONCLUSIONS
  The marked reduction in perinatal mortality rates seen during the study period without an increase in cesarean sections indicates that the decrease in perinatal mortality was not impacted by cesarean section rates. The plausible hypothesis seems to be that the reduction in perinatal mortality of deliveries performed under the supervision of university services was more likely to be associated with better neonatal care rather than the mode of delivery.
authors.affiliation: Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil. gduarte@fmrp.usp.br
authors.forename: Geraldo
authors.initials: G
authors.lastname: Duarte
authors.forename: Pedro S
authors.initials: PS
authors.lastname: Coltro
authors.forename: Rebeca V
authors.initials: RV
authors.lastname: Bedone
authors.forename: Antonio A
authors.initials: AA
authors.lastname: Nogueira
authors.forename: Glauce M
authors.initials: GM
authors.lastname: Gelonezzi
authors.forename: Laércio J
authors.initials: LJ
authors.lastname: Franco
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data / Q000639:trends; D036861:Delivery, Obstetric / Q000639:trends*; D005260:Female; D046689:Fetal Mortality; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D009321:Natural Childbirth / Q000706:statistics & numerical data / Q000639:trends; D011247:Pregnancy; D012189:Retrospective Studies; D013525:Surgical Instruments / Q000706:statistics & numerical data / Q000639:trends