This is a retrospective study analysing the reasons behind the
observed increasing rate of caesarean section (C/S) over a
10-year period (1990-99) in the obstetric unit of Jordan
University Hospital. All the indications of C/S carried out in
the unit were analysed. The duration of the study was divided
into 2, of 5 years each (1990-94, 1995-99). There was a 6.9%
increase in the C/S rate over the second half of the study
period. This was statistically significant (P < 0.001). All the
indications contributed significantly to rise. Fetal distress
had the highest contribution 33.5%, while repeat C/S and
malpresentation contributed to 21.5% and 21.3%, respectively.
This increase was not associated with a significant change in
the perinatal mortality. The rise in the caesarean section rate
was higher in primigravida compared with multigravida (10.9% vs
6.2%). Fetal distress has the highest contribution in
primigravida. In multigravida, if we exclude repeat caesarean
section, the major indications were fetal distress and
malpresentation. The percentage of elective and emergency
caesarean section was similar in both study periods. The reasons
behind the increase C/S rate couldn't be understood. Probably a
lower threshold concerning the decision to perform the C/S
rather than a change in obstetric management in responsible for
this rise.
Institution
Department of Obstetrics and Gynaecology, Jordon University
Hospital, Amman, Jordan.
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