Can the rate of cesarean section be reduced?

OBJECTIVE: To look into all cases with previous one cesarean section who were cared for and delivered at Armed Forces Hospital, Riyadh, between January 1990 and December 1998, to determine its prevalence, final method of delivery, and outline measures of reducing its incidence.

METHODS: Retrospective analysis of hospital records of all women with previous one cesarean section who had either a repeat cesarean section or delivered vaginally after cesarean section.

RESULTS: Between 1990 and 1998, 61,060 mothers were delivered. Two thousand five hundred and seventy eight patients had one previous cesarean section. They represented 3.5% of the total number of deliveries. Nine hundred and sixty eight (37.5%) cases had repeat cesarean section. Of the 1610 (62.5%) mothers who achieved vaginal delivery, 102 (6%) had ventouse, 42 (3%) had forceps and 22 (1%) had an assisted breech delivery. Rupture of uterine scar was reported in 15 cases. There were no maternal or perinatal deaths.

CONCLUSION: Patients with one previous cesarean section are three times more likely to have a cesarean section as compared to mothers with unscarred uterus. Reducing the overall cesarean section rate is possible through a closer look at the primary indication for the first cesarean section. A protocol is needed to allow more cases with one or more previous cesarean section to have trial of vaginal delivery under close monitoring and involve the senior staff more in the diagnosis and management of cases of dystocia and the use of Oxytocin when indicated.