[Indications for third and more than three cesarean sections--analysis and pattern of practice].
OBJECTIVE
Authors aimed to analyse indications for third and more than three times cesarean sections (c. s.), as well as, to make an assessment of the adequacy of the taken decisions.


METHODS
It was conducted a retrospective study for third and more than three times cesarean, including period 1991-2003 in the Department of Obstetrics and Gynaecology, Medical University, Pleven. During that time 28645 births has taken place, 2971 of which are by cesarean section. 2,5% from the last, has been third and more than three times cesarean. Using expert judging, indications for the last were divided into three groups-right, disputable and wrong.


RESULTS
In the cases with only one mentioned indication "Re-re c.s." 37,8% (28 patients), ratio between right, disputable and wrong was 2:1:1 and the same ratio in the cases with indication "Re-re c.s.+ other indications" 58,1% (43 patients), was 5:1:1. In 4,3% of the cases (3 patients) no indication "Re-re c.s." was mentioned.


CONCLUSIONS
Reduction of third and more than three times cesarean can be achieved by more careful judgement of indications in second, "disputable", group and erradication of the "wrong", which most commonly are jatrogenic reasons. This will result in diminishing the increasing frequency of abdominal births, as well as, preventing possible complications for mother, connected with operation.
Popov
I
I
Stoĭkov
S
S
Iudova
N
N
Lukanova
M
M
Khristova
I
I
D002031:Bulgaria; D017604:Cesarean Section, Repeat / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology; D012044:Regression Analysis; D012189:Retrospective Studies