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Differences in rate and medical indication of caesarean section between Germany and Japan
Author(s) -
Fröhlich Matthias,
Koga Chie,
Bührer Christoph,
Mori Chisato,
Yamamoto Midori,
Sakurai Kenichi,
Hinkson Larry
Publication year - 2020
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.14340
Subject(s) - medicine , cephalopelvic disproportion , caesarean section , fetal distress , distress , obstetrics , population , pregnancy , german , cohort , pediatrics , demography , fetus , environmental health , clinical psychology , history , genetics , archaeology , sociology , biology
Background There are growing concerns about the increasing rate of caesarean section (CS) worldwide. Various strategies have been implemented to reduce the proportion of CS to a reasonable level. Most research on medical indications for CS focuses on nationwide evaluations. Comparative research between different countries is sparse. The aim of this study was to evaluate differences in the rate and indications for CS between Japan and Germany in 2012 and 2013. Methods Comparison of the overall rate and medical indications for CS in two cohort studies from Germany and Japan. We used data from the German Perinatal Survey and the Japan Environment and Children's Study (JECS). Results We analyzed data of 1 335 150 participants from the German perinatal survey and of 62 533 participants from JECS and found significant differences between the two countries in CS rate (30.6% vs 20.6%) and main medical indications: cephalopelvic disproportion (3.2% vs 1.3%; OR: 2.4 [95% CI: 2.2–2.6]), fetal distress (7.3% vs 2.3%; OR: 3.4 [95%‐CI: 3.2–3.6]), and past uterine surgery/repeat CS (8.4% vs 8.8%; OR: 0.9 [95%‐CI: 0.9–1]). Conclusion There are differences in the rate and medical indications for CS between Germany and Japan at the population level. Fetal distress was identified as a medical indication for CS more often Germany than in Japan. Considering the substantial diagnostic uncertainty of electronic fetal monitoring (EFM) as the major indicator for fetal distress, it would seem to be reasonable to rethink CS decision algorithms.