Can the Rate of C-sections Performed in a Level I Perinatal Center Be Reduced? - An Analysis of the University Gynecology Clinic Rostock, 2008 - 2014

Abstract

Introduction: In Germany the rate of deliveries by cesarean section is continually increasing. Many different reasons have been put forward to explain this trend. The aim of this study was to examine how the C-section rate developed at the University Gynecology Clinic Rostock, one of the biggest maternity hospitals and level I perinatal centers in Germany, based on various maternal and neonatal parameters. The aim was also to identify potential risk factors for C-sections.

Material and method: Various obstetric parameters were obtained from the birth cohort (2008 to 2014; n = 20 091) of the University Gynecology Clinic Rostock. The data was used to calculate parameter-specific C-section rates. Potential risk factors for C-section were identified by regression analysis.

Results: The C-section rate dropped from 26.24% to 23.57%. The rate of repeat C-sections also declined. The mean age of the pregnant women increased. Nevertheless, the frequency of cesarean sections in pregnant women aged more than 35 years declined. Rates of being overweight or obese preconception increased. C-section rates increased as BMI values preconception increased. There was a perceptible trend towards attempting the vaginal delivery of children in breech presentation and of twins. The frequency of depressed neonates after vaginal delivery and after C-section decreased. Rates for mild and advanced acidosis increased after both C-sections and vaginal deliveries. Previous C-section, older maternal age, overweight and obesity prior to conception, breech presentation and multiple pregnancies all increased the risk of cesarean sections.

Conclusion: This study showed that reducing the rates of C-sections without a deterioration in neonatal outcomes can be achieved even in a large maternity hospital that cares for many high-risk pregnancies.

Keywords: breech presentation; cesarean section; neonatal outcome; twins.

Fig. 1

C-section rate and percentages of primary and secondary C-sections compared to the total number of C-sections performed in one year for the period 2008 to 2014.

Fig. 2

Mean overall maternal age and mean age of women who had a C-section between 2008 and 2014.

Fig. 3

Percentage of depressed neonates with an Apgar score ≤ 7 point at 5 minutes between 2008 and 2014.

Fig. 4

Percentage of newborns with acidosis (UApH < 7.20) between 2008 and 2014.

Abb. 1

Sectiorate und Anteil der primären und sekundären Sectiones an den Sectiones eines Jahres zwischen 2008 und 2014.

Abb. 2

Maternales Durchschnittsalter gesamt und bei Sectio zwischen 2008 und 2014.

Abb. 3

Anteil deprimierter Neugeborener mit einem Apgar-Wert ≤ 7 Punkte nach 5 Minuten zwischen 2008 und 2014.

Abb. 4

Anteil der Neugeborenen mit Azidose (NApH-Wert < 7,20) zwischen 2008 und 2014.