Cesarean section (CS) is an essential obstetric intervention when clinically indicated, but sustained increases in its use raise concerns regarding avoidable maternal risk, future reproductive consequences, and pressure on health-system resources. Updated local evidence is needed to distinguish between emergency and elective procedures and to describe the indications driving hospital practice. A retrospective hospital-based record review was conducted at Duhok Maternity Hospital, Kurdistan Region, Iraq, and included all deliveries from January 2020 to December 2024. Data were extracted from hospital records on mode of delivery, type of CS (emergency or elective), maternal age, parity, previous cesarean scars, and the primary recorded indication for CS. Descriptive statistics were used to summarize trends, and associations between CS type and maternal characteristics were assessed using the chi-square test, with a p-value <0.05 considered statistically significant. Among 79,174 total deliveries, 28,062 were cesarean sections, corresponding to an overall CS rate of 36.84%. The total CS rate remained consistently high throughout the study period. Within this overall rate, emergency CS declined over time, whereas elective CS increased significantly (p < 0.001). Maternal age, parity, and number of previous cesarean scars were significantly associated with CS type. Emergency CS was more common among younger and nulliparous women and among women without a previous scar, whereas elective CS predominated among multiparous women and those with one or more previous scars. Fetal distress and failure of progress were the leading recorded indications for emergency CS, while abnormal presentation, post-date pregnancy, bad obstetrical history, and previous cesarean scar were frequent indications for elective CS. Cesarean delivery accounted for more than one-third of all births in this tertiary hospital, substantially exceeding the population benchmark proposed by the World Health Organization. The findings suggest that repeat cesarean delivery is an important contributor to the growing proportion of elective procedures. Regular audit of indications, closer review of primary cesarean decisions, and wider implementation of evidence-based labor management and vaginal birth after cesarean policies may help optimize CS use in this setting.
Cesarean section (CS) is an essential obstetric intervention when clinically indicated, but sustained increases in its use raise concerns regarding avoidable maternal risk, future reproductive consequences, and pressure on health-system resources. Updated local evidence is needed to distinguish between emergency and elective procedures and to describe the indications driving hospital practice. A retrospective hospital-based record review was conducted at Duhok Maternity Hospital, Kurdistan Region, Iraq, and included all deliveries from January 2020 to December 2024. Data were extracted from hospital records on mode of delivery, type of CS (emergency or elective), maternal age, parity, previous cesarean scars, and the primary recorded indication for CS. Descriptive statistics were used to summarize trends, and associations between CS type and maternal characteristics were assessed using the chi-square test, with a p-value <0.05 considered statistically significant. Among 79,174 total deliveries, 28,062 were cesarean sections, corresponding to an overall CS rate of 36.84%. The total CS rate remained consistently high throughout the study period. Within this overall rate, emergency CS declined over time, whereas elective CS increased significantly (p < 0.001). Maternal age, parity, and number of previous cesarean scars were significantly associated with CS type. Emergency CS was more common among younger and nulliparous women and among women without a previous scar, whereas elective CS predominated among multiparous women and those with one or more previous scars. Fetal distress and failure of progress were the leading recorded indications for emergency CS, while abnormal presentation, post-date pregnancy, bad obstetrical history, and previous cesarean scar were frequent indications for elective CS. Cesarean delivery accounted for more than one-third of all births in this tertiary hospital, substantially exceeding the population benchmark proposed by the World Health Organization. The findings suggest that repeat cesarean delivery is an important contributor to the growing proportion of elective procedures. Regular audit of indications, closer review of primary cesarean decisions, and wider implementation of evidence-based labor management and vaginal birth after cesarean policies may help optimize CS use in this setting.
