[Evolution of the indications for cesareans. Comparison of 1971-1976 and 1976-1979 at the Maternity Center of the Louis-Mourier Hospital. Review of the literature].
Changes in the indications for caesarean operations were studied over a period of 9 years from 1971-1979 and two periods from 1971-1975 and 1976-1979 were compared. The principal changes that show up are: an increase in the total number of caesarean sections from 5.3% in 1971 to 15.4% in 1979; modifications in the indications which were mainly due to much greater use of electronic means of monitoring the fetus and an improvement in the methods of resuscitation of the newborn (there were approximately the same number of caesareans for breech presentations, an increase in the number of repeat caesarean operations and of caesarean operations for fetal distress and for dystocia as well as for toxaemia of pregnancy); the improvement in the state of infants at birth seems to be parallelled by the increase in the number of caesarean operations. Though there was 8% neonatal morbidity, only 1% of these at the most could be put down to the caesarean; no maternal death occurred, although caesarean section is accompanied by an increased maternal morbidity of 27%. Reviewing the literature shows that the same tendencies occur in other places. This makes it possible to point out the ways in which action can be taken to limit the number of caesareans in those categories where the indications seem to be most frequent, namely dystocia, repeat caesareans, fetal distress and breech presentation. The optimum level of caesarean sections at 15% with 9% being first caesareans and 6% repeat caesareans should be kept to.