title: Indications for cesarean deliveries during a 7-year period in a tertiary hospital.
abstract: BACKGROUND
  To analyze the cesarean section rate evolution in a tertiary hospital and the main indications for cesarean section.
  
  
  METHODS
  A retrospective study was conducted at a major academic hospital and included 5 751 women who had a cesarean section from 2005 to 2011. The rates of overall, primary and repeat cesarean sections were analyzed. A linear regression and adjusted R-square were used to access the relative contribution of each indication to the variation in primary cesarean section.
  
  
  RESULTS
  During the 7-year period of the study the cesarean section rate decreased from 30.9% to 27.6%. This was due to a decrease in primary cesarean section (21.9% to 18.2%), although an increase in repeat cesarean section was observed (9.0% to 9.4%). Among the indications for primary cesarean section, maternal-fetal indications and malpresentation were the ones that decreased the most with adjusted R-square of 0.70 and 0.55, respectively.
  
  
  CONCLUSIONS
  The collected data identified that the decrease in the cesarean section rate at the hospital resulted from a decrease in primary cesarean section deliveries, especially the ones performed for maternal-fetal indications and malpresentation.
  
  
  CONCLUSIONS
  The decrease in primary cesarean section rate may be attributed to several changes in medical policies in the Department, such as the implementation of an external fetal version program, the induction of labor only after the 41st week of gestation in low-risk pregnancies and the trial for vaginal birth in maternal-fetal disease. Nevertheless subjective indications such as labor arrest disorders and nonreassuring fetal heart rate are still major contributors for primary cesarean section rate.
authors.affiliation: Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução. Hospital de Santa Maria (Centro Hospitalar Lisboa Norte). Lisboa. Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Costa
authors.affiliation: Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução. Hospital de Santa Maria (Centro Hospitalar Lisboa Norte). Lisboa. Portugal.
authors.forename: Catarina
authors.initials: C
authors.lastname: Policiano
authors.affiliation: Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução. Hospital de Santa Maria (Centro Hospitalar Lisboa Norte). Lisboa. Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Clode
authors.affiliation: Departamento de Obstetrícia, Ginecologia e Medicina da Reprodução. Hospital de Santa Maria (Centro Hospitalar Lisboa Norte). Lisboa. Portugal.
authors.forename: Luís M
authors.initials: LM
authors.lastname: Graça
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013997:Time Factors