الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
CS rates are increasing globally without any signs of slowing down. Worldwide rates have increased from about 6% in 1990 to 19% in 2014. In Egypt, according to the last Egyptian Demographic Health Survey 2014, 52% of deliveries in Egypt were by CS in the previous six years before 2014. Overuse of CS has not shown benefits and can create harm. Many decisions to use CS are driven by the clinical or psychological needs of the mother or by the clinical needs of the baby, or by both.Despite the expansion of cesarean section rates, there is no evidence reveals improved outcomes for the mother or the baby. Moreover, cesarean delivery has more potential adverse consequences than vaginal delivery. Moreover, unnecessary cesarean delivery is unethical issue due to the various expenses that are imposed by the health system. The World Health Organization (WHO) states that no region in the world is justified in having a cesarean rate greater than 10 to 15 percent Identifying the underlying factors for the continuing increase in CS use could improve the efficacy of interventions.The current study was conducted to estimate the most recent rate of C.S in Alexandria, Egypt 2017 and to identify the main indications as reported by the women themselves in a way to plan a series of intervention programs to tackle the problem of C.S.It was a community based study as a cross sectional study was conducted in the period between July 2017 and October 2017 includes post- partum women attending public health care settings to vaccinate their infants at the age of four months with DPT vaccine according to the national expanded program of immunization (EPI). Two centers were selected randomly from each district in Alexandria to conduct the study in. Women were inquired about the mode of the last delivery (n=1177). Out of those delivered by C.S (n=709) only 512 agreed to participate in the study. They were interviewed using a structured questionnaire includes data about socio-demographic characteristics, obstetric history, type and indication of the last C.S.The statistical analysis was conducted using the software SPSS (Statistical Package for Social Science) version 20.0.The findings of the current work are summarized as follow:The overall CS rate among studied women was 60.2%. The Highest rates of CS delivery were found at Al Agamy, Sharq and Al-Montazah health districts (79.1%, 74.3%, 73.5%) respectively. The age of the interviewed women ranged from 15 to 50 years, with a mean of 28.91 ± 6.24 years, and a median of 28 years. Nearly half of them aged between 20 to 30 years. only 9.2% and 19.1% complete their secondary and university education, respectively. The majority (83.6%) of them were housewives. The last inter-birth interval among interviewed women ranged from less than one year to 18 years, with a mean of 3.15 ± 2.35 years and a median of 3 years. more than three quarter of the sample (79.4%) had previous cesarean section. Nearly all of the interviewed women (99.0%) paid antenatal care visits during their last pregnancy. The mean number of visits among the studied women was 7.05±2.02.
• Out of all CS conducted 61.5% were recommended by physician and 38.5% were upon maternal request. Moreover, Two thirds (66.8%) of CS deliveries were performed electively, however 33.2% were emergency.
• Among medically indicated CS deliveries, previous CS delivery was the cause in 42.9% of deliveries. Other less common causes include failure of vaginal delivery to progress, eclampsia and premature rupture of membrane (PROM) (11.4%, 7.3% and 5.1%, respectively) • Among C.S deliveries conducted upon maternal request, tocophobia was the commonest cause (33.0%) followed by misconception that once CS always CS (21.3%). Enforcement from relatives and friends considered as the main factor for 16.8% of the studied women• Comparison between medically indicated CS deliveries and those upon maternal request showed that there is a significant differences between districts regarding the indication for CS as 42.6% of women with C.S upon maternal request were residing Shark district, moreover in Wassat district the proportion of CS conducted upon maternal request was higher than those recommended by physicians. 94.4% of women who delivered C.S upon their requests were residing urban regions in Alexandria as compared to 79.4% of the other group and this difference was statistically significant as p<0.001
• No other statistically significant difference were found between deliveries upon women’s request and those medically indicated regarding any of studied characteristics namely sociodemographic, past obstetric and delivery data. A significantly higher proportion of women delivered by emergency C.S aged less than 20 years as compared to those with elective CS (8.2% versus 1.5%). Moreover, 18.2% of women with emergency CS aged 40 years or higher as compared to 4.4% in the elective group, these differences were statistically significant as p<0.001. The level of education showed a significant difference between elective and emergency CS as higher proportion of women with emergency CS was illiterate or just read and write as compared to women in the elective group (32.9% versus 13.7%). On the other hand 13.5% of women in the emergency CS group were university educated as compared 21.9% of elective group as p<0.001.
• A significantly higher gravidity, parity and number of living children were observed among emergency CS deliveries. On the other hand, higher number of antenatal care visits and higher proportion of previous CS deliveries were found among those with elective CS.
• 70.4% of elective CS deliveries were conducted in private health settings as compared to only 34% of emergency CS and this difference was statistically significant.The present study concluded that the percentage of CS deliveries is on rise in Alexandria with an average of 60 % reaching up to 79 % in some districts. CS deliveries upon maternal request accounts for 38.5% of all CS among whom tocophobia and misconception that once cesarean always cesarean were the most common cited reasons. Young women of high social class might be a priority target group for intervention to raise their awareness about risks of CS and changing their attitude towards vaginal delivery.