RESUMO
The rise in cesarean section [CS] rates seen throughout the world has been a source of concern in many countries. The aim of this study was to investigate both the main determinants of CSs and the trend in CS rates at the Kuwait Maternity Hospital from 1973 to 1989. The records of all deliveries at the Kuwait Maternity Hospital during the 17-year study period were scrutinized to determine the main indications for the CS and to calculate the annual rate of CS. For comparison, the study was divided into two periods, 1973-1980 and 1981-1989. The results showed that the CS rate increased from 3.9% in 1973 to 12.6% in 1989 [p < 0.0001]. There was a rapid increase in the CS rate from 1973 to 1980 and a gradual but consistent increase from 1981 to 1989. The main indications for performing a CS were failure to progress in labor, previous CS, fetal distress, abnormal presentation and medical disorders in pregnancy. All individual indication rates increased during 1981-1989 when compared to 1973-1980. During the second period, previous CS became the dominant indication. The CS rate of 12.6% in 1989 was comparable to the low rates recorded in Europe. It could, however, be lowered in response to the prevailing pronatalistic attitude of the community. Involvement of senior staff in the decision to perform a CS is advocated