2018; 03(01): 001-009 cdr/18/1821/gmj

Original Research Article

Indications for caesarean sections and actions to prevent unnecessary caesareans

Mira Hansson Bittar1, Paula da Silva Charvalho2, Ylva Vladic Stjernholm2
1Educational Programme in Medicine
2Department of Women´s and Children´s Health, Karolinska University Hospital and Karolinska Institutet, Stockholm, SE-171 76 Stockholm, Sweden

Correspondence to
Ylva Vladic Stjernholm, Department of Women´s and Children´s Health, Karolinska University Hospital and Karolinska Institutet, Stockholm, SE-171 76 Stockholm, Sweden

First Published Online 07 September 2018

ABSTRACT

Aim: Background: Indications for planned, urgent and immediate caesarean sections were analysed in order to suggest adequate actions to prevent unnecessary caesareans. Study design: Data were obtained from the Swedish Medical Birth Register, the Swedish Pregnancy Register, and from original obstetric records at a university hospital in Sweden between the early 1990s and 2015. Results: Caesarean section rate increased concomitantly with increasing labour induction and decreasing instrumental deliveries. Most of the planned caesareans in 2015 were carried out for psychosocial/non-medical reasons and the prevalence increased from 0.6% to 4.6% of all deliveries between the early 1990s and 2015 (p < 0.001). Secondary fear of vaginal delivery after a negative birth experience was reported by 60% of these women. Second most common indication of previous uterine scar (two or more caesareans, a transmural corporal incision or pathological placentation) increased from 1.2% to 2.3% (p < 0.001). Most of the urgent caesareans in 2015 were performed because of prolonged labour and the rate increased from 2.1% to 5.4% of all deliveries between the early 1990s and 2015 (p < 0.001). Second most common indication imminent foetal asphyxia accounted for 2.4% and 2.6% in the early 1990s and 2015 respectively (p < 0.01). Conclusions: Unnecessary urgent caesareans could be prevented through reduced labour induction, evidence-based management of labour, structured support during delivery, and by performing instrumental deliveries instead of caesareans. Such actions, taken together with systematic counseling and support during pregnancy would reduce planned caesareans for psychosocial/non-medical reasons, repeated caesareans or pathological placentation.

Keywords: Caesarean section; delivery; fear; instrumental delivery; labour induction

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