The Israel perinatal census.

During a period of 3 months a nationwide perinatal census was carried out covering a total of 30 obstetric wards in 27 Israeli hospitals and the records of all births from a questionnaire were prospectively examined. There were 22815 births in the country. 90.4% of the deliveries were completed vaginally and 9.6% by Cesarean section (80% as an emergency procedure). The perinatal mortality rate was 13.5/1000. 1080 women who had one previous Cesarean birth were compared to 14703 women with a previous vaginal birth. From those with one previous Cesarean section 55.1% delivered vaginally and 44.9 abdominally. According to a logistic regression analysis breech presentation and one uterine scar were the most important risk factors for Cesarean section as opposed to breech presentation maternal disease and multiple pregnancy for perinatal mortality. The national Cesarean section rate in breech presentation was 57.8%. The chance for vaginal delivery was 67.2% provided the woman had delivered vaginally. The indication for a repeated cesarean section were a previous Cesarean section (28.7%) and malpresentation (12.8%). Uterine rupture ensued in 1.2% (13 cases) of post Cesarean women giving vaginal birth and in only .02% (4 cases) among those who had no previous Cesarean section (P<0.001). Comparison between primiparas (42000 deliveries or 18.4% of the total) and multiparas showed that preeclampsia hypertension and diabetes mellitus were significantly more frequent among older patients. Preeclampsia and hypertension were more common among primiparas than multiparas (P<0.001). In grand multiparity (7th or more parity) diabetes hypertension malpresentations multiple births large-for gestation age deliveries and perinatal deaths were significantly more common. The mean birth weight was 3222 +or- 551 g and the low birth weight (less than 2500 g) was 6.9% with nonsignificant differences between the various ethnic groups. Perinatal mortality was higher for infants born in breech presentation than in cephalic presentation 23/1000 compared to 3.2/1000 respectively. The level of obstetrics in Israel was measured by the perinatal mortality and the Cesarean section rate was comparable to that of Great Britain Norway the Netherlands and France.