Indications for cesarean section in singleton pregnancies in two Danish counties with different cesarean section rates.

OBJECTIVE

To compare the clinical indications for delivery by cesarean section (CS) in singleton pregnancies in two Danish counties with different CS rates, and to describe the relation between CS in the two counties and parity, mother's age, type of delivery department, gestational age at birth, and birthweight.

DESIGN

A population-based, follow-up study based on antecedent data.

SETTING

Two Danish counties, where women deliver in obstetric as well as surgical departments, with a CS rate of 8.3% and 15.2%, respectively.

SUBJECTS: All pregnant women in the two counties who delivered in 1989.

MAIN OUTCOME MEASURES: Comparison of the rates of CS in the two counties carried out for five well-defined clinical indications: Previous cesarean section, breech presentation, dystocia, fetal distress, and other. SECONDARY MEASURES: Neonatal and maternal outcomes.

RESULTS

In the county with the higher frequency of CS, all indications for CS were used significantly more often, except from 'fetal distress' in primiparous women. In this county 'breech presentation' was the commonest indication among primiparous women, whereas 'fetal distress' was the most common in the county with the lower CS rate. For multiparous women the highest CS rates in both counties were found among women who had had a previous CS. The major difference between the two counties was the threefold greater risk of CS indicated by 'dystocia' among multiparous women in the county with the higher CS rate.

CONCLUSION

The regional differences in CS could not be explained by differences between the two populations or by an increased rate of a single indication, but could be due to differences in obstetric practice or expectations or demands from the pregnant women.