Indications associated with increased cesarean section rates in a Swedish hospital

Objective: To analyze the indications and Robson classes associated with the rapid increase in cesarean section (CS) rates at Söder Hospital, Stockholm, Sweden, in the late 1990s. Method: Records of women who underwent CSs in 1994 and 1999 at Söder Hospital were retrospectively reviewed. Diagnostic frequency and Robson class, which takes into account characteristics such as parity, previous deliveries, prematurity, and fetal presentation, were compared for the 2 years. Results: Suspected fetal distress (+ 1.6%; P = .0001), maternal request (+ 1.5%; P < .0001), and labor dystocia (+ 0.8%; P = .03) were associated with the increase in CS rates. The rate of CSs with cephalic presentation and spontaneous onset of labor at term, as well as the rate of CSs following induced labor or elective CSs, increases significantly in both nulliparas and multiparas (Robson classes 1–4) (P < .02). Conclusion: The increasing CS rate was due to maternal preference and lower thresholds of decision for physicians.