Trends in Cesarean Section Rates and Indications over the Last 5 Years in a Tertiary Center

Background: Cesarean section (CS) is necessary and lifesaving in certain situations, but many tertiary centers report high and increasing use. Objective: To discuss articles on CS rates and indications in tertiary hospitals over the last five years. Methods: A PRISMA guided systematic review was conducted. We included English language, record based observational studies from tertiary centers reporting CS rates or indications with data covering at least one year within a recent five year window. We extracted data including (setting, study period, sample size, CS rate, indications, emergency and elective status, and Robson Ten-Group contributions). Findings were qualitatively synthesized. Results: Eight studies from Africa and Asia were included. CS rates ranged from 21.6% to 55.0%. One study reporting time points found increasing CS rates and rising maternal request CS. Where indications were reported, previous cesarean, uterine surgery and fetal distress were most frequent, while failure to progress and mal presentation also recurred. Four studies applied the Robson classification; Group 5 was the leading contributor. Conclusion: Recent tertiary center study found high CS rates, commonly driven by repeat CS and fetal status indications. Robson based audit and targeted efforts to reduce avoidable primary CS should be considered to improve safety and reduce variation.