[Indications of primary cesarean deliveries in a regional teaching hospital and reasonable strategies for reducing them].
OBJECTIVE
To characterize the indications of primary cesarean sections and discuss the various possibilities to reduce them.


METHODS
Retrospective study, carried out over a period of 1 year in a university hospital having a level 3 perinatal activity, including the 499 primary cesarean sections of 2013. Two groups were defined by parity: nulliparous patients (group 1) and multiparous patients who had never previously been delivered by cesarean section (group 2). We have assessed the indication of every primary cesarean section and health status of newborns in each group.


RESULTS
Groups 1 and 2 respectively included 369 and 130 patients. The cesarean section rate in 2013 was 24.7% with a primary cesarean section rate of 17%. Seventy-four percent of the primary caesarean deliveries were performed on nulliparous women and 26% on multiparous (P<0.001). Sixty-three percent of the primary caesarean deliveries were performed on nulliparous women with a singleton fetus in cephalic presentation. The most common indications for primary cesarean delivery were non-reassuring fetal heart rate tracing (47.1%), failure to progress (24.8%) for which nulliparous women were more involved (29% vs. 13%, P<0.001) and fetal malpresentation (9.6%).


CONCLUSIONS
Further analysis of fetal heart rate during labor, a larger use of second line means to evaluate the fetal status during labor, using 6cm as the cut off for active labor, and encouraging vaginal operative delivery constitute the best way to decrease the primary cesarean section rate.
Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France.
P
P
Zelli
Service de santé publique et médecine sociale, centre d'investigation clinique 003, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France.
B
B
Boussat
Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France.
A
A
Wetzel
Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France.
C
C
Ronin
Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France; Université Joseph-Fourier, BP 53, 38041 Grenoble cedex 09, France.
J-C
JC
Pons
Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France; Université Joseph-Fourier, BP 53, 38041 Grenoble cedex 09, France. Electronic address: sergent.fabrice@chu-amiens.fr.
F
F
Sergent
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D006340:Heart Rate, Fetal; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000601:surgery; D010298:Parity; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult
Anomalies du rythme cardiaque fœtal; Défaut de progression; Failure to progress; Fetal malpresentation; Non-reassuring fetal heart rate; Première césarienne; Primary cesarean delivery; Présentation dystocique