Changing primary cesarean section patterns at a private hospital.

The primary cesarean section patterns for a two-year premonitoring period, 1967 and 1968, and a two-year postmonitoring period, 1977 and 1978, were determined and compared at a private hospital. The frequency of cesarean section deliveries increased from 5.0% to 14.6% during those times. Cephalopelvic disproportion as an indication for cesarean section was more common than the combined total of breech presentation and fetal distress. Cephalopelvic disproportion increased as a diagnosis from 0.8% to 4.1% (5 X ) of deliveries; breech presentation, from 0.4% to 2% (5 X ); and fetal distress from 0.1% to 0.8% (8 X ). A changing patient population was identified as one contributing factor to the rising cesarean section rate. Allowing patients an adequate trial of labor with or without oxytocin stimulation, applying strict criteria for attempting a vaginal breech delivery and utilizing fetal scalp blood sampling with abnormal fetal heart rate tracings are suggested ways to decrease the cesarean section rate without compromising perinatal morbidity and mortality.