[Changes in indications for cesarean section from 1977 to 1983. Apropos of 18,605 deliveries].

Between 1977 and 1983 there were 18,605 women delivered in the maternity unit of St-Antoine Hospital. Of these 2,382 had caesarean operations, which is a percentage of 12.8. This percentage rose in a statistically significant way between 1977, when it was 8.8% and 1984 when it was 14.9%. Three groups of indications for caesarean operations were classified. These are: absolutely essential caesareans (feto-pelvic disproportion, placenta praevia, transverse lies). Prophylactic caesareans (uterine scars, breech presentations and fetal distress) and caesarean operations judged eventually to be necessary (dystocia in labour, high blood pressure and maternal pathology). The rise in the caesarean operations in the period of years studied came mainly from the increase in prophylactic caesarean operations, which reflected a progressive change in the attitude of obstetricians in the department. A study of the literature shows that this change coincided with a parallel change in many countries without there having been any concerted action between the countries, and also because there was a general desire to control the great rise in the number of caesareans and to find the optimum number that should be performed.