[Changes in the cesarean section percentage].

Abstract

More and more cesarean sections (C/S) are done, rate multiplied by 3 or 4 in occidental countries in these post two decennials, but are really too many done (?), as it is regularly reproched to the obstetricians, even though perineonatal morbidity and mortality rates have improved. By help of files studied in the gynecological and obstetrical Ward of Saint Antoine's Hospital Paris over 60 years, the authors have tried to answer to a few basic questions: The reason to be of the first C/S before labor and during labor, and the reason to be of iterative C/S in the same conditions. What results is: The rate of C/S has barely changed fur the following causes: Important dystocia known before or during labor, or Chronic foetal distress. On the other hand it increased because of: Acute foetal distress revealed during labor by alteration of the foetal heart beat (FHB). Stagnation of dilatation often accompanied by alteration of the FHB. An increase of iterative C/S due themselves to the increased number of scarred uteri. To reduce the progression of the number of C/S, we should therefore try to: Reduce the amount of scarred uteri, therefore have better knowledge of the indication of the first C/S. But is it feasible without compromising the benefits acquired by modern obstetrics, in means of perineonatal mortality and morbidity? Accept more often birth by vaginal route on the scarred uteri, the actual means of surveillance of labor appear to be able to permit it.