Increase in cesarean delivery rates is the biggest obstacle to the reduction of feto-maternal morbidity

Aim: Cesarean delivery, whose incidence is already high, has started to increase due to the increase in both labor induction and multiple pregnancy rates due to ART. The cesarean section rate to reduce maternal and fetal morbidity should be 10% or less. This study was planned to compare cesarean and vaginal delivery rates, indications, fetal and maternal morbidity and mortality rates performed in Istanbul Training and Research Hospital over a ten-year period. Material and Methods: During the ten-year period between January 2000 and January 2009, 17150 patients who gave birth were included in the study. Demographic data of the patients were obtained retrospectively from their files. Maternal age, gravida, parity, length of hospital stay and cesarean section indications were recorded. Those who had one or more previous cesarean sections and those who had previous cesarean section due to myomectomy constituted the secondary cesarean section group. Those who had a cesarean section for the first time constituted the primary cesarean section group. Frequency of normal and cesarean delivery rates, indications for cesarean section, early and late maternal and fetal morbidity and mortality rates were compared. Results: The total number of patients participating in the study, including normal vaginal delivery and cesarean section, was determined as 17150. While 9310 of them gave birth by cesarean section, 7840 cases delivered vaginally. While the number of patients with previous and repeated cesarean section was 3180, the number of patients with first cesarean section was 6130. Previous and repeated cesarean sections were recorded as the most common cesarean indication (48%). The second most common cesarean indication is fetal distress (18.4%). The third most common indication for cesarean section is cephalo-pelvic incompatibility (11.2%), which was found in 67 cases. The fourth most common cesarean indication is presentation-position anomaly, which was detected in 53 cases (8.8%). When compared with the primary cesarean section group, the rates of hemorrhage, urinary infection, fever, wound dehiscence and re-operation were found to be significantly higher in the secondary cesarean section group. When compared with the secondary cesarean section group, fetal birth weight was found to be significantly higher in the primary cesarean section group. Fetal length, head circumference, 1st and 5th minute APGAR scores were found to be similar in both groups. Discussion: Despite efforts by healthcare providers and governments to promote normal vaginal delivery, both cesarean section and feto-maternal morbidity continue to increase.