title: Indications for Cesarean Delivery in Mexico: Evaluation of Appropriate Use and Justification.
abstract: Cesarean delivery is one of the most widely used surgical interventions in Latin America and in many cases it is performed with no clear medical indication. Our objective was to analyze the relationship between reported indications for a cesarean and support for that indication in the clinical record in four Mexican hospitals, during the 2006-2007 period.
  
  
  
  The data are from 604 (37.1%) women from a total of 1,625 who were admitted to the hospital in labor, and who gave birth through cesarean. Multivariate logistical regression analysis was used to explore the association between indications for clinically justified or unjustified surgery and other clinical and sociodemographic variables.
  
  
  
  Supporting clinical information for indications of cesarean delivery were found in only 45 percent of the cases considered. The adjusted statistical analysis showed that the variables associated with an unjustified indication for cesarean were: not having had a prior birth (OR 1.84 [95% CI 1.16-2.89]), having a maximum cervical dilation of 4 centimeters or less at time of cesarean (OR 2.44 [95% CI 1.53-3.87]), and having received care in a private hospital (OR 6.11 [95% CI 1.90-19.57]).
  
  
  
  The indications for cesarean related to labor dynamics were those least supported. Not having had a prior birth poses the greatest risk of having a poorly supported indication for a cesarean delivery. It would be prudent to institute audits, and greater requirements for and surveillance of documentation for cesarean delivery indications.
authors: Education and Research in Health, Area General Hospital Number 5 Zacatepec Morelos, Mexican Social Security Institute Delegation Morelos, Mexico.
authors: Juan Carlos
authors: JC
authors: Aranda-Neri
authors: Division of Reproductive Health, National Institute of Public Health, Mexico, Cuernavaca, Mexico.
authors: Leticia
authors: L
authors: Suárez-López
authors: San Francisco, CA, USA.
authors: Lisa M
authors: LM
authors: DeMaria
authors: Departments of Obstetrics, Gynecology & Reproductive Sciences and of Global Health Sciences, University of California, San Francisco, CA, USA.
authors: Dilys
authors: D
authors: Walker
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D016208:Databases, Factual; D003695:Delivery of Health Care / Q000592:standards*; D019937:Diagnostic Techniques and Procedures; D005260:Female; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008800:Mexico / Q000453:epidemiology; D015999:Multivariate Analysis; D009774:Obstetrics / Q000592:standards*; D011247:Pregnancy; D055815:Young Adult
keywords: Mexico; appropriate use; cesarean delivery; diagnostic techniques; health care deliveries