Abstract
BACKGROUND: A caesarean section is a life saving procedure for both the mother and the baby. However, the fact that caesarean section rates are increasing worldwide, in both the developed and developing countries is becoming an issue of increasing concern, which raised a concern. The purpose of this study was to evaluate the indications for a caesarean section in the Rundu State Hospital. 
 
 METHODS: A cross sectional retrospective study was conducted.The study population comprised the records of women who had undergone caesarean section between 1 January 2017 to 31 March 2017. After conducting a sample size calculation the delivery, records of 149 women who had undergone a caesarean section during the study period were reviewed. The required data was collected using individual data collection sheets and then analysed using SPSS version 24.
 
 RESULTS: The age of participants ranged between 20 and 50 years. The mean age for the study group was 25.1 years. The overall leading indications for a caesarean section included foetal distress (25.6%), previous uterine scar (18.1%) and Cephalopelvic disproportion (16.1%) while other major contributing indications were eclampsia (16.1%), mal-presentation (8.1%), prolonged labour (6.7%, ante partum haemorrhage (3.4%), failed vaginal birth after caesarean section (2.0%), cord prolapse (1.3%) and severe vaginal warts (0.6%). In addition, the study found that a primary caesarean section was more common at 81.9% as compared to previous uterine scar at 18.1 % while maternal indications contributed to 61% of caesarean sections while foetal indications constituted 39%.
 
 CONCLUSION: Overall, the study found that the leading indications for caesarean section were foetal distress and previous uterine scar. It was recommended that foetal distress, as the main indicator for a primary caesarean section, should be further confirmed with a printed cardiotocograph. Training health workers on the interpretation of cardiotocograph and the importance of the use of other methods, such as the fetoscope and doptone, may help to reduce the incidence of unnecessary primary caesarean section due to foetal distress. In addition, previous uterine scar cases should be embark on labour before a decision is made.
Highlights
A caesarean section is a life saving procedure for both the mother and the baby
The study found that a primary caesarean section was more common at 81.9% as compared to previous uterine scar at 18.1 % while maternal indications contributed to 61% of caesarean sections while foetal indications constituted 39%
Overall, the study found that the leading indications for caesarean section were foetal distress and previous uterine scar
Summary
The fact that caesarean section rates are increasing worldwide, in both the developed and developing countries is becoming an issue of increasing concern, which raised a concern. Women who undergo a C/S are likely to have a repeat C/S in a subsequent pregnancy, increasing the C/S rate in a country with poor resources (Betrán et al, 2007). There is ample evidence in the existing literature that there is increased maternal and neonatal morbidity and mortality associated with caesarean deliveries worldwide when compared to a normal vaginal delivery (NVD) (Kirchengast & Hartmann, 2019). A recent study identified that the risks of placenta praevia, morbidly adherent placenta and obstetric haemorrhage in subsequent pregnancies increase in the case of repeated C/S (Xu et al, 2019)
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