Caesarean Delivery - What Has Changed in 50 Years

Abstract

Introduction Caesarean section (CS) is a surgical procedure when a newborn is delivered through laparotomy and hysterotomy. In some medical conditions CS is a crucial procedure to ensure a safe delivery [1]. Over the years CS rates have increased significantly in the whole world. Lithuania follows this global trend, with CS rates increasing from 9.49% in 1995 to 26.01% in 2012 [2], and reaching 24.0% in 2024 [3]. Current risk factors contributing to CS include advanced maternal age, previous CS, and other obstetric factors [4]. Aim To analyse and compare tendencies in caesarean section in the years 1970 and 2020. Methods Data about the course of labor, neonates and mothers was collected from the Hospital of the Lithuanian University of Health Sciences, Kaunas Clinics, birth records of July - September months of 1970 and 2020. The study included only singleton gestations: 307 births in 1970 and 285 in 2020. Newborns were grouped by weight: Group 1 < 2500 g, Group 2 2500 - 3999 g, Group 3 ≧ 4000 g. Chi-square test was used to identify differences, 𝛂=0.05. Results The incidence of CS increased from 3.3% in 1970 to 26% in 2020 (p<0.001). This increase was particularly pronounced in preterm deliveries (from 9.1% to 43.3%, p=0.04) and term deliveries (from 3.1% to 23.9%, p<0.001). Among preterm deliveries, the youngest neonate in 1970 was 33 weeks of gestation, compared to 27 weeks in 2020. The proportion of preterm deliveries increased significantly over the study period, from 3.6% in 1970 to 10.5% in 2020 (p<0.001). Differences in delivery type were also observed according to neonatal weight. The increased incidence of CS in term labours was mainly observed in the second weight category, rising from 3.1% to 24.8% (p<0.001). In the third weight group, the increase was statistically significant but smaller, from 3.4% to 23.1% (p=0.003). Among documented causes of CS in 1970, placental pathologies and transverse fetal presentation were the most common (5/10 cases). In 2020, the leading indications for CS were previous CS (20.3%), cephalopelvic disproportion (18.9%), breech presentation (13.5%), and maternal pathology (9.5%). In 1970, 14 cases of complete breech presentation were recorded, all delivered vaginally, compared to 12 cases in 2020, of which 9 (75%, p<0.001) were delivered by CS. Three cases of footling breech presentation occurred in both years; in 1970 all were delivered vaginally, whereas in 2020 all were delivered by CS (p=0.014). Conclusions The prevalence of caesarean deliveries has increased by more than 7 times between 1970 and 2020. This change is observed in pre-term and full-term deliveries. The rise in CS rates was particularly pronounced among preterm deliveries and in neonates of higher weight categories, suggesting that gestational age and fetal size remain important determinants for operative delivery.