الفهرس 
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Abstract
Cesarean section (CS) delivery is considered a lifesaving operation for both the mother and her fetus. Recently, CS rates have increased worldwide and most of these deliveries had no medical indication. World health organization considered the ideal rate for cesarean section to be 10-15%. When CS rates rise towards 10 %, the number of maternal and newborn deaths decreases, but when the rate goes above 10%, there is no evidence that mortality rates improve. In 2008, the Egyptian Demographic Health Survey (EDHS) showed that the rate of CS was 25%, while the 2014 Health Issue Survey (HIS) showed that more than 50% of deliveries were by CS. The population Council reported that rates of CS have been continuously rising since the year 2000 and have more than doubled between 2008 and 2014, reaching a rate of 67% of hospital-based births in 2014. Recently, changes in financial, social, cultural factors and decrease in vaginal births after cesarean (VBAC) influenced the rising of non-medical indications for cesarean section, including Cesarean delivery on maternal request (CDMR). Robson, a consultant obstetrician and gynecologist at the national maternity Hospital, First proposed the fool-proof system for studying worldwide C.S rates back in 2001. Robson classification of Caesarean section rates and indications allows evaluation and comparison of the contributors to the Caesarean section rate and their impact. It also allows comparison between institutions, regions, and countries that adopt this classification. Robson’s system classifies all deliveries into one of ten groups on the basis of five parameters: obstetric history (parity and previous caesarean section), onset of labor (spontaneous, induced, or caesarean section before onset of labor), fetal presentation or lie (cephalic, breech, or transverse), number of neonates, and gestational age (preterm or term). Although CS rates have been increasing worldwide, especially in the Arab region including Egypt, increasing the risk of morbidities and mortalities for both the mother and the fetus, few studies were found focusing on CS in tertiary referral hospitals. None was found describing the trend of CS in Mansoura University Hospital. The aim of the current study was to assess the rates and the indications of caesarean delivery according to Robson classification at M.U.H (A major tertiary referral hospital in the Delta region in Egypt) over one-year period (1/1/2016 to 31/12/2016). One thousand and one hundred ninety-six females were included in this retrospective study. The following data was fulfilled from Obstetrics and Gynecology Department of Mansoura University: Detailed history taking including age, residence, occupation, medical history, and infertility history. Clinical assessment of the current pregnancy including gravidity, parity, fetal number, presentation and pregnancy abnormalities. The 10 Robson classification groups were reported among all participants. 1. Nulliparous, single cephalic, ≥37 weeks, spontaneous labor. 2. Nulliparous, single cephalic, ≥37 weeks, induced or cesarean before labor. 3. Multiparous (excluding previous cesareans), single cephalic, ≥37 weeks, spontaneous labor. 4. Multiparous (excluding previous cesareans), single cephalic, ≥37 weeks, induced or cesarean before labor. 5. Previous cesarean, single cephalic ≥37 weeks. 6. All nulliparous breeches. 7. All multiparous breeches (including previous cesareans). 8. All multiple pregnancies (including previous cesareans). 9. All abnormal lies (including previous cesareans). 10. All single cephalic, ≤36 weeks (including previous cesareans). Results of this study showed that: • The average age 27.71 years, the youngest was 17 years and the oldest was 41 years. • Regarding the medical history, there were (5.6%) had Diabetes Miletus (DM), (4.5%) had hypertension, (1.3%) had Ischemic heart disease, (10.5%) had history of preeclampsia and (0.9%) had history of (DVT). • Regarding the number of uterine scars, there were no scars in (35.7%), there was one scar in (22.5%), there were two scars in (20.9%), three scars in (16.6%), four scars in (3.8%) and five scare in (0.4%). • Regarding the factors in CS decision making according to Robson classification, it was: DM in 2.5% of the cases, Hypertension in 2.17% of the cases, Ischemic heart disease in 0.65% of the cases. Preeclampsia in 6.69% of the cases, DVT in 0.6% of the cases, Infertility in 3.91% of the cases, ICSI in 2.61 % of the cases. Parity in 0.11% of the cases, gestational age 2.17% of the cases, presentation in 6.47% of the cases, fetal number in 4.08% of the cases. Uterine scars in 41.03% of the cases. Low-lying placenta in 5.33% of the cases, amount of liquor in 9.78% of the cases, IUGR in 1.41% of the cases, fetal distress in 4.08% of the cases, IUFD in 1.41% of the cases, APH in 4.41% of the cases, CPD in 2.12% of the cases and PTL in 1.2% of the cases. So, the number of uterine scars was the main factor for CS decision making. • Regarding the Classification of the included cases according to Robson’s classification, there was: 2.3 % of the cases of group 1. 1.3 % of the cases of group 2a, 9.2 % of the cases of group 2b. 1.8 % of group 3. 0.4 % of the cases of group 4a, 5.7% of the cases of group 4b. 44.8 % of group 5. 1.8 % of the cases of group 6. 5 % of the cases of group 7. 7.6 % of the cases of group 8. 3.6 % of the cases of group 9 and 16.6 % % of the cases of group 10. So, group 5 (multiparous, term, cephalic presentation and previous cesarean section) then group 10 (cephalic preterm pregnancies) was the main groups in this study according to Robson’s classification. Regarding the identified other causes that may increase the tendency of having CS including CPD, fetal distress, DVT, PET, ICSI, antepartum hemorrhage, oligohydramnios, diabetes, IHD, membrane rupture, and older age