CESAREAN SECTION IN THE WORLD AND CROATIA I. Incidence, Indications, Mortality and Morbidity, Repeated section
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Sažetak The rise in frequency, the indications, maternal and neonatal mortality and morbidity following cesarean section (CS) respective the problem of repeated CS is presented. The frequency of CS in Northern America at the 80-ies of past century increased up to over 21%, that in some European countries was achieved in the 90-ies. In Croatia the frequency is increasing since 1992, from 8,3% up to 15,1% in the 2003. The indications have changed. Beforehand the fetopelvine disproportion was the main indication, in about 75% of cases (0,75% of all deliveries); today the disproportion has the same rate of all deliveries, but it is only about 5% of increased rate of over 15% of CS cases. The extended indications (repeated SC, breech presentation, uterine dystocia and fetal distress) make nowadays about two thirds of all CS cases. Maternal mortality significantly decreased, but it is still now manifold higher than at vaginal births. Maternal morbidity at CS is still significantly higher, especially the infections and thromboembolic disease. Neonatal outcome. Following CS, depending upon fetal pathology, the newborn’s chance for survival and for reducing late complications are increased. Repeated CS is a consequence of higher rate of primary CS. The vaginal delivery is connected to higher possibility of uterine scar rupture or dehiscence. At births after previous CS the lowest maternal morbidity is in cases of successful vaginal deliveries, higher in elective CS and the highest in CS after unsuccessful attempt of vaginal birth.