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ABSTRACT
Background: Cesarean section (CS) rates have been increasing worldwide with different effects on maternal and neonatal health. Factors responsible for the growing trend of CSs, include maternal characteristics, medical insurance and convenient scheduling or financial incentives. Effective interventions and guidelines are required to reduce CS rates. Objective: The aim of this research was to investigate the factors contributing to CS rate increase and their correlation with international guidelines. Methods: The performed analysis included the available socio-demographic and medical information retrieved from the medical records and a related questionnaire in both emergency and elective CSs. Results: Out of the included 633 births, the cesarean delivery rate was 58%. Women with a previous CS showed higher percentages for Elective CS (66.1%) compared to Emergency CSs for the same reasons (8.9%). Furthermore, 23% of the patients underwent an Emergency CS because of failure of labor to progress while 18% of CSs were due to maternal desire. Conclusion: The high rates of CS in Greece demonstrate the lack of use of international obstetric protocols, national strategies, Cesarean Section audits and a significant shortage of midwives. A decrease in iatrogenic and non-iatrogenic factors leading to the primary CS will decrease CS rates.
Keywords: Cesarean Section, elective cesarean section, emergency cesarean section, risk factors for cesarean sections, cesarean section and international guidelines.
1.BACKGROUND
Cesarean Section (CS) rates have been increasing in recent decades worldwide with negative effects on maternal and neonatal health (1). CS is associated with an increased risk of intra- and postoperative complications (2), infant's obesity, diabetes, respiratory morbidity, and atopic dermatitis in childhood (3, 4) and an increased risk of placenta previa in subsequent pregnancies (5, 6).
The World Health Organization (WHO) indicated that both very low and very high CS rates could be dangerous, that the ideal CS rate ranges from 10% to 15% (7) and emphasized that a CS rate >10% is not associated with a reduction in maternal-neonatal mortality. In northern Europe, most countries have maintained CS rates <20%, with very low perinatal mortality rates (8) while in Greece, over 50% of the deliveries are cesarean deliveries. The actions implemented to reduce CS were evaluated during the 54th session of the United Nations Committee for the Elimination of Discrimination against Women. The results...