الفهرس 
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Abstract
section is one of the most commonly performed surgical operations worldwide. The increasing rate of non-medically indicated cesarean sections raise the health risks for mothers and their babies and result in increased health care costs compared with vaginal deliveries. CS rate now is far above WHO recommendations. We explored aspects that relate to the practice of cesarean section that might shed light on determining why cesarean section rate is increasing, how we could reduce that increasing rate.
This study was aimed to clarify the prevalence of CS in tertiary health care level and secondary health care level and compare between them as regards the prevalence rate of CS, indications, and complications of CS.
It was a retrospective analytical study. We had chosen Menoufia University Hospital as tertiary care and Menouf General Hospital as secondary care. It was conducted at the department of obstetrics and gynecology and in Patient affairs and statistics unit of both centers mentioned from April 2018 to January 2019.
Records of women who performed CSs at both centers from 1st January till 31st December 2017 were retrospectively reviewed. This takes into account characteristics such as age, parity, gestational age at delivery, previous delivery mode, an indication of cesarean delivery, neonatal outcome and maternal complications.
The prevalence of cesarean section in both hospitals is markedly increased over the time period from 2013 to 2017.
Comparing CS rates between Menouf General Hospital and Menoufia University Hospital, it was higher in Menoufia University Hospital (59.34%) than Menouf General Hospital (53.50%).
The indications of cesarean section were divided into maternal and fetal indications.
The study revealed that the most common indications of CS at Menoufia University Hospital were the previous CS 85.53%, followed by oligohydramnios 7.78%, severe preeclampsia 6.80%, breech malpresentation 5.06%, placenta praevia and accrete 4.98%, cephalopelvic disproportion 2.19%, post-term pregnancy 1.74%, failed trial of labor 1.51%, twins pregnancy 1.66%, antepartum hemorrhage 1.81%, IUGR 1.25% and fetal disterss1.59%.
In Menouf General Hospital, the most common indication for CS was previous CS 88.72% followed by oligohydramnios 11.12%, post-term pregnancy 4.60%, failed trial of labor 3.07%, severe preeclampsia 2.97%, IUGR 1.25%, breech malpresentation 7.67%, twins 2.97%, cephalopelvic disproportion 4.89%, placenta praevia, and placenta accrete 2.68% and antepartum hemorrhage 2.40%.
In our study, we noted that CS due to medical disorders was common at Menoufia University Hospital, 12 cases (0.91%) compared with Menouf General Hospital level 3 cases (0.28%). These cases include a case of round cell carcinoma of the lung, decompensated liver disease, lupus nephritis, acute fatty liver of pregnancy and Bud Chiarri syndrome.