{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T15:42:02Z","timestamp":1788277322971,"version":"build-2803163510"},"reference-count":28,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2020,2,12]],"date-time":"2020-02-12T00:00:00Z","timestamp":1581465600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The cesarean delivery rate has been increasing globally in recent decades. The reasons for this are complex and subject to ongoing debate. Investigation of the indications for cesarean delivery and how these have changed over an extended period of time could provide insight into the reasons for changing obstetric practice. Our objective was to explore contributing factors to the increasing rate of cesarean delivery by examining the incidence of and indications for cesarean delivery over the past three decades at our institutions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>We conducted a retrospective observational study of all cesarean deliveries, from 24\u00a0weeks\u2019 gestational age onwards, within an inner\u2010city hospital network in Sydney, Australia, between August 1989 and December 2016. The primary outcome measures were the rates of and indications for emergency and planned cesarean delivery. We also examined our data within the Robson 10\u2010Group Classification system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 147\u00a0722 births over the study period, with 37\u00a0309 cesarean deliveries for an overall rate of 25.3%. The rate of cesarean delivery increased from 18.7% in 1989\u20101994 (8.7% emergency, 10% planned) to 30.4% in 2010\u20102016 (11.4% emergency, 19% planned). Emergency cesarean delivery for slow progress increased from 3.4% to 5.5% of all births (a relative increase of 62%) and other emergency cesareans mainly performed for suspected intrapartum fetal compromise increased from 5.2% to 5.6% (a relative increase of 8%). Previous uterine surgery (predominantly cesarean section) was the largest contributor to the increase in planned procedures from 3.8% to 9.0% of all births, and 29% of all cesarean deliveries. Primary cesarean delivery for planned antenatal fetal indications, previous pregnancy problems, multiple gestation and maternal choice all increased substantially in combined rate from 0.7% to 4.9%. Cesarean rates in Robson groups 6, 7 and 8 (term breech and multiple gestations) increased most over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The increased rate of cesarean delivery is mainly attributable to a greater number of procedures performed for slow progress in labor, breech presentation or repeat cesarean section.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.13816","type":"journal-article","created":{"date-parts":[[2020,1,24]],"date-time":"2020-01-24T05:51:56Z","timestamp":1579845116000},"page":"909-916","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Cesarean delivery: Trend in indications over three decades within a major city hospital network"],"prefix":"10.1111","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8586-2392","authenticated-orcid":false,"given":"Rhett","family":"Morton","sequence":"first","affiliation":[{"name":"RPA Women and Babies Royal Prince Alfred Hospital Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7342-8516","authenticated-orcid":false,"given":"Alice Elizabeth","family":"Burton","sequence":"additional","affiliation":[{"name":"RPA Women and Babies Royal Prince Alfred Hospital Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praneel","family":"Kumar","sequence":"additional","affiliation":[{"name":"RPA Women and Babies Royal Prince Alfred Hospital Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon Anthony","family":"Hyett","sequence":"additional","affiliation":[{"name":"RPA Women and Babies Royal Prince Alfred Hospital Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hala","family":"Phipps","sequence":"additional","affiliation":[{"name":"RPA Women and Babies Royal Prince Alfred Hospital Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9679-9827","authenticated-orcid":false,"given":"Kevin","family":"McGeechan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health The University of Sydney School of Public Health University of Sydney Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5620-0170","authenticated-orcid":false,"given":"Bradley Stephen","family":"de Vries","sequence":"additional","affiliation":[{"name":"RPA Women and Babies Royal Prince Alfred Hospital Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,2,12]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13592"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/0144361031000098316"},{"key":"e_1_2_8_4_1","first-page":"289","article-title":"Cesarean section rates and indications in Greece: data from a 24\u2010year period in a teaching hospital","volume":"31","author":"Tampakoudis P","year":"2004","journal-title":"Clin Exp Obstet Gynecol"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2007.01307.x"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.3109\/01443610903191269"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2009.01100.x"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.06.058"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1053\/beog.2000.0156"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-11-8"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.01.026"},{"key":"e_1_2_8_12_1","unstructured":"Australian Institute of Health and Welfare 2001\u20132018.Australia\u2019s mothers and babies 1999\u20132016. Perinatal statistics series [Internet].Canberra:AIHW;2019[cited 10 June 2019]. 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