title: The changing indications and rates of cesarean section in one academic center over a 16-year period (1997-2012).
abstract: OBJECTIVE
  To compare trends and rates of cesarean section delivery by indication in one academic center.
  
  
  METHODS
  A retrospective analysis of the indications of all cesarean sections performed in Edith Wolfson Medical Center, Holon, Israel, a tertiary healthcare university facility, during 1997-2012 was done. Each delivery was assigned to the primary indication noted for that pregnancy, regardless of other indications reported. Whenever more than one indication was present, the principle indication chosen by the attending obstetrician was chosen for the analysis.
  
  
  RESULTS
  The cesarean section rate gradually rose from 15.29% in 1997 to 21.10% in 2012, with an overall cesarean section rate of 20.66%. The cesarean section rate between 1997 and 2000 was 17.52%, between 2001 and 2004 was 18.5%, between 2005 and 2009 was 22.86%, and between 2009 and 2012 was 22.07% (p < 0.001). The five leading primary indications across the years were previous cesarean section (26.0%), non-reassuring fetal heart rate pattern (18.1%), malpresentation (16.9%), labor dystocia (8.8%), and suspected macrosomia (7.2%).
  
  
  CONCLUSIONS
  Previous cesarean section persistently increased and was the leading indication throughout the years. Any attempt to reverse this trend must be based on reduction of the primary cesarean section rate.
authors: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Israel. Electronic address: drslurie@hotmail.com.
authors: Samuel
authors: S
authors: Lurie
authors: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.
authors: Amir
authors: A
authors: Shalev
authors: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
authors: Oscar
authors: O
authors: Sadan
authors: Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
authors: Abraham
authors: A
authors: Golan
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000639:trends*; D004420:Dystocia / Q000453:epidemiology; D005260:Female; D005316:Fetal Distress / Q000453:epidemiology; D006801:Humans; D007557:Israel / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*
keywords: cesarean section; indications for cesarean section; primary cesarean section rate; secondary cesarean section rate