Trends and Medical Indications of Cesarean Section in the Public Health Sector

Cesarean section is a common obstetric intervention used to save the lives of women and newborns during childbirth-related complications. Its prevalence has risen significantly worldwide in recent years. Understanding cesarean section rates and indications is crucial for evaluating this widespread obstetrical practice and optimizing care management. This study aimed to examine the trends and medical indications for cesarean sections in Duhok City, Kurdistan Region, Iraq. This hospital-based cross-sectional study was conducted at the Maternity Teaching Hospital in Duhok City, Kurdistan Region, Iraq, from January 4 to August 16, 2024. A convenience sampling technique was used to recruit 400 women admitted for cesarean deliveries. Data were collected using a structured questionnaire covering sociodemographic and maternal factors, while cesarean indications were extracted from medical records. Descriptive statistics were analyzed using SPSS version 23, with a significance level set at p < 0.05. The findings revealed a significant increase in cesarean delivery rates from 31.5% in 2015 to 36.1% in 2023 (P <0.0001), marking a 4.6% rise over eight years. The most common indication for cesarean section was a previous cesarean delivery (35%). For primary cesarean sections, the leading indications included fetal distress (18.5%), breech presentation (13.5%), oligohydramnios (12.4%), failure to induce labor (11.3%), and maternal medical conditions (11%). Among repeat cesareans, the predominant reasons were prior cesarean history (64.3%), a fresh surgical scar (13.2%), and oligohydramnios (12%). Additionally, women's age (P = 0.013), education level (P = 0.04), and parity (P < 0.0001) were significantly associated with the type of cesarean section performed. The cesarean delivery rate in this region has increased beyond the optimal range recommended by the World Health Organization (WHO). Multiple sociodemographic, maternal, and clinical factors contribute to this trend. To address this issue, targeted strategies should be developed to reduce both primary and repeat cesarean sections while ensuring maternal and neonatal safety.