High cesarean section rate: a new perspective.

Cesarean section rates in the United States have increased dramatically in recent years, whereas perinatal mortality rates have fallen. To investigate the hypothesis that these two events are not necessarily causally related, a prospective attempt to modify obstetric management directed at minimizing the rate of abdominal delivery while preserving excellent perinatal survival was done at a university-affiliated hospital in the Denver metropolitan area. Unselected patients who were admitted to separate services at the hospital were used for comparison, with one group subject to the specific management criteria. Corrected mortality rates and low five-minute Apgar scores on the two services were not significantly different after two years. The total cesarean section rate on the first service was 5.7%, and the total cesarean section rate on the comparison service was 17.6%. Analysis of the data showed major differences in indications for cesarean section in the areas of repeat cesarean section, cephalopelvic disproportion, breech presentation, fetal distress, and genital herpes. These data support the contention that excellent perinatal outcome can be achieved with modest abdominal delivery rates.