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Five-year trends in modes of delivery in Turkish public hospitals: Maternal age distribution of primary and primiparous cesarean sections
Selma Dağcı1, Volkan Kızılay2, Melike Pündük Yılmaz3, Çiğdem Kılınç4, İclal İlknur Özdemir5, Sedat Akgol41Istanbul Provincial Health Directorate, Istanbul, Turkey2Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
3Department of Obstetrics and Gynecology, Haseki Training and Research Hospital Affiliated with University of Health Sciences Istanbul, Turkey
4Department of Gyneacological Oncology, Gazi Yaşargil Training and Reserach Hospital, Diyarbakır, Turkey
5Department of Midwifery, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
INTRODUCTION: This study aimed to examine temporal trends in vaginal and cesarean deliveries in public hospitals in Istanbul between 2020 and 2024, with a focus on primary and primiparous cesarean sections across maternal age groups.
METHODS: This retrospective, descriptive, multicenter study included delivery records from six public maternity hospitals affiliated with the Ministry of Health in Istanbul, Türkiye. All live births at ≥24 weeks of gestation with complete demographic and delivery data were analyzed. Primary cesarean was defined as the first cesarean delivery in a woman, and primiparous cesarean was defined as a cesarean delivery in a woman giving birth for the first time. Maternal age was categorized into four groups: 15–18, 19–35, 36–39, and ≥40 years. Data were extracted from electronic medical records, cross-verified against official statistics, and analyzed using descriptive statistics, chi-square tests, and the Cochran–Armitage trend test.
RESULTS: A total of 78,998 deliveries were recorded, of which 40,427 (51.1%) were vaginal deliveries and 38,571 (48.9%) were cesarean sections. The annual cesarean rate increased from 45.8% in 2020 to 51.2% in 2023 before slightly declining to 50.9% in 2024 (p<0.0001). Primiparous cesareans accounted for 11.8% of births and showed a significant upward trend (p<0.001), while primary cesarean rates remained stable (13.1%, p=0.412). Most primary and primiparous cesareans occurred among women aged 19–35 years, with notable increases among adolescents.
DISCUSSION AND CONCLUSION: Cesarean rates in Istanbul’s public hospitals remain far above the thresholds recommended by the World Health Organization, with high proportions of primary and primiparous procedures. Targeted strategies addressing high-risk subgroups, standardization of classification systems, and strengthening care through greater involvement of midwives are urgently needed to reduce unnecessary cesarean deliveries.
Keywords: Cesarean rates, maternal age, primiparous.
Manuscript Language: English
