Indications for caesarean delivery between 1955 and 2005.
BACKGROUND
We wished to evaluate the changes in the indications and rates of caesarean delivery over the past 50 years (1955-2005) at the Ljubljana Maternity Hospital, the largest maternity hospital in Slovenia and a tertiary center.


METHODS
We retrospectively analyzed data obtained from delivery records, archived at the Department of Obstetrics and Gynecology, University Medical Center Ljubljana, for the selected years 1955, 1965, 1975, 1985, 1995 and 2005. The records were archived in bound books (1955), folders (1965 and 1975), on microfilm (1985) and in the national perinatal information system (1995 and 2005). Caesarean delivery rates were calculated and indications statistically analyzed.


RESULTS
Of the 38.499 reviewed delivery records, 3122 were the records of caesarean deliveries. The caesarean delivery rate was 2.5% in 1955, 4.95% in 1965, 7.36% in 1975, 7.54% in 1985, 11.76% in 1995 and 15.74% in 2005. Overall, 80 different indications were registered and analyzed, 35 with an incidence>1.0%. The most frequently used indications were caesarean after caesarean, cephalopelvic disproportion, acute fetal distress and malpresentation.


CONCLUSIONS
During the 50-year period, the parameters contained in delivery records changed as the result of new approaches and changing attitudes toward the parturient woman, the course of labor and delivery. In 1955 and 1965, maternal indications prevailed, whereas in 1995 and 2005 some new and nonobstetrical indications were introduced and the fetal and maternal indications became equally important. A general observation was that combinations of indications had a constantly high share over the analyzed period, implying that the decision on caesarean delivery was often based on several different indications. The caesarean delivery rate is increasing, therefore obstetricians should, in line with a good clinical practice, base their decisions on well founded arguments.
Bregar
Andreja Trojner
AT
Department of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia. atb@t-2.net
Cerar
Vasilij M
VM
Slavec
Zvonka Zupanic
ZZ
Verdenik
Ivan
I
D052178:Cephalopelvic Disproportion / Q000453:epidemiology / Q000601:surgery; D002585:Cesarean Section / Q000706:statistics & numerical data / Q000639:trends*; D017604:Cesarean Section, Repeat / Q000639:trends; D005260:Female; D005316:Fetal Distress / Q000453:epidemiology / Q000601:surgery; D006771:Hospitals, Maternity; D006801:Humans; D007746:Labor Presentation; D011247:Pregnancy; D012189:Retrospective Studies; D018154:Slovakia; D014600:Utilization Review / Q000706:statistics & numerical data