A Review of Primary Caesarean Sections in Tasmania

EDITORIAL COMMENT: Changes in practice should be evaluated. Rising rates of Caesarean section should be questioned in terms of fetal results and risks to the mother. Perinatal mortality rates are easily calculated but the justification of an increased Caesarean section rate is likely to be an improved quality of survival of the infant — this information is not readily available but must not be overlooked in the Caesarean section argument. Finally, the perinatal mortality rate associated with Caesarean section cannot be expected to fall when the increased rate takes in more of the fetuses at greatest risk (prematurity ±breech presentation, severe preeclampsia, premature rupture of the membranes, antepartum haemorrhage). Summary: In the years 1975–1982 inclusive there were 55,095 deliveries in Tasmania and of these 2,738 patients (4.9%) were delivered by primary Caesarean section. The primary Caesarean section rate increased from 4.3% in 1975 to 6.6% in 1982. This increase has been due to the increased incidence of primary Caesarean section associated with breech presentation and to a lesser extent fetal distress. Although the overall perinatal mortality rate fell from 19.5 per 1,000 births in 1975 to 10.8 per 1,000 births in 1982, there has been no corresponding fall in the perinatal mortality rate associated with primary Caesarean section. As an increase in Caesarean section will lead to an increase in maternal mortality and morbidity it is considered that an active review of the reasons for the rise in Caesarean section should be undertaken by those hospitals where the rate is unusually high.