The Impact of Non-Clinical Factors on the Rate of Caesarean Section in Egypt

Objective: Caesarean section (CS) rates have been increasing worldwide. The objective of our study was to investigate the factors indicating CS in two major hospitals in Cairo, Egypt, and to assess the impact of non-clinical factors such as physician convenience and the patient’s socioeconomic status on the rate of CS deliveries. Study Design: Prospective cross-sectional study. Methods: Demographic, socioeconomic and medical information of all C.S deliveries, between 01/01/09 and 31/05/09, were prospectively analyzed (n=2544). Results: The overall rate of CS was worryingly high at 36.7%. The CS rate in the teaching hospital was 35.2% (n=2274), while the CS rate in the military (non-teaching) hospital was 57.6% (n=270). The indications for the caesarean sections were classified as reasonable (1381 women, 54.2%) and unreasonable (1163 women, 45.7%). The commonest indications in the reasonable C.S group were previous !2 C.S (18%), malpresentations (8%), failed labor progress (7.43%), antepartum hemorrhage (4.5%). The commonest indications in the unreasonable C.S group were previous C.S with no trial of scar (20%), severe preeclampsia (4.5%) and poorly defined fetal distress (3%). Conclusions: Factors as young age, low parity, low educational level, high monthly income, induced labor, delivery in private sectors and time of delivery (midnight to 8am) played significant roles in increasing the rate of unreasonable (poorly justified) C. S. The results of this study lend support to the hypothesis that physicians are motivated to perform CS for social, financial and convenience incentives.