What is the most common indication for cesarean (cesarian) delivery worldwide?

Most Common Indications for Cesarean Delivery Worldwide

The most common indication for primary cesarean delivery worldwide is dystocia (labor abnormalities/failure to progress), accounting for approximately 37% of all primary cesarean deliveries, followed by nonreassuring fetal heart rate at 25% and abnormal fetal presentation at 20%. 1

Primary Cesarean Delivery Indications

• Dystocia/Labor abnormalities/Failure to progress: Represents 37% of all primary cesarean deliveries and is the leading indication globally 1
• Nonreassuring fetal heart rate/Fetal distress: Accounts for 25% of primary cesarean deliveries and is often the most urgent indication requiring immediate intervention 1, 2
• Abnormal fetal presentation (primarily breech): Constitutes approximately 20% of primary cesarean deliveries 1, 3
• Failed instrumental delivery (forceps or vacuum): Represents about 3% of primary cesarean deliveries 1
• Other indications: Account for approximately 15% of primary cesarean deliveries, including conditions such as placenta previa, maternal medical conditions, and multiple gestations 1

Repeat Cesarean Delivery Indications

• Previous cesarean delivery without vaginal birth after cesarean (VBAC) attempt: Represents 82% of all repeat cesarean deliveries and is a significant contributor to the overall cesarean rate 1, 3
• Failed VBAC attempt: Accounts for approximately 17% of repeat cesarean deliveries 1
• Failed instrumental delivery after previous cesarean: Represents about 0.4% of repeat cesarean deliveries 1

Regional Variations and Trends

• In some regions, particularly in developing countries, fetal distress has been reported as the most common indication in certain hospitals, accounting for up to 28% of cesarean deliveries 2
• Previous cesarean section is becoming an increasingly common indication globally, contributing significantly to the rising cesarean rates worldwide 4, 3
• The rate of cesarean delivery has been increasing globally over the past three decades, from approximately 18.7% in the early 1990s to over 30% in recent years 3

Clinical Implications

• The rising rate of primary cesarean deliveries directly contributes to the increase in repeat cesarean deliveries, as previous cesarean section is the largest contributor to planned cesarean procedures 3
• Reducing primary cesarean delivery rates and encouraging VBAC in appropriate candidates could significantly decrease the overall cesarean delivery rate 4, 5
• Maternal morbidity is approximately 2.5 times higher with cesarean delivery (2.23%) compared to vaginal birth (0.9%), highlighting the importance of appropriate patient selection 1, 4

Risk Considerations

• Multiple repeat cesarean deliveries are associated with increasing risks of complications, including:
  • Wound and uterine hematoma (4-6%) 1
  • Placenta previa (1-2%) 1
  • Need for blood transfusion (1-4%) 1
  • Hysterectomy (0.5-4%) 1
  • Placenta accreta (0.25-3%) 1

Understanding these indications and their prevalence is crucial for developing strategies to address the rising cesarean delivery rates while maintaining optimal maternal and neonatal outcomes.