title: Trends in cesarean delivery: rate and indications.
abstract: OBJECTIVE
  To compare the cesarean delivery rates over the last decade and to examine the indications contributing to changed trends, if any.
  
  
  METHODS
  To compare the rate and indications of cesarean delivery over the last decade, the data were collected in a retrospective manner from all the deliveries that occurred between January 1 and December 31 in 2001, 2006, and 2011, in the department of obstetrics and gynecology, Seth G.S. Medical College and K.E.M. Hospital, a large tertiary care municipal hospital in Western India. A cohort of 20853 delivered women was studied. The rates and indications of primary and repeat cesarean sections were analyzed among the live births to estimate the relative contribution of each indication to the overall increase in rate.
  
  
  RESULTS
  The cesarean delivery rate increased from 171.70 to 289.30 per 1,000 live births, with an increase in primary cesarean delivery rate from 118.53 (69.03 %) in 2001 to 210.09 (72.62 %) in 2011 per 1,000 live births. Fetal distress, arrest of descent, multiple gestations, and fetal indications contributed to this increase.
  
  
  CONCLUSIONS
  There is a significant increase in the total cesarean rate with primary cesarean accounting for most of the increase.
authors.affiliation: Seth G.S. Medical College & K.E.M. Hospital, 602/3-C, Samrudhhi CHS, Vaishali Nagar, K.K. Marg, Jacob Circle, Mahalaxmi (East), Mumbai, 400011 India.
authors.forename: Shiba
authors.initials: S
authors.lastname: Mittal
authors.affiliation: Seth G.S. Medical College & K.E.M. Hospital, 602/3-C, Samrudhhi CHS, Vaishali Nagar, K.K. Marg, Jacob Circle, Mahalaxmi (East), Mumbai, 400011 India.
authors.forename: Sachin
authors.initials: S
authors.lastname: Pardeshi
authors.affiliation: Seth G.S. Medical College & K.E.M. Hospital, 602/3-C, Samrudhhi CHS, Vaishali Nagar, K.K. Marg, Jacob Circle, Mahalaxmi (East), Mumbai, 400011 India.
authors.forename: Niranjan
authors.initials: N
authors.lastname: Mayadeo
authors.affiliation: Seth G.S. Medical College & K.E.M. Hospital, 602/3-C, Samrudhhi CHS, Vaishali Nagar, K.K. Marg, Jacob Circle, Mahalaxmi (East), Mumbai, 400011 India.
authors.forename: Janki
authors.initials: J
authors.lastname: Mane
keywords: Cesarean rate; Indications; Primary cesarean birth; Repeat cesarean birth