A Comparison of Indications for Cesarean Delivery

INTRODUCTION: This study reviewed the major indications for cesarean delivery performed by Médecins Sans Frontières Operational Center Brussels to improve gynecologists aspiring to work in humanitarian settings. METHODS: The surgical procedures performed by Médecins Sans Frontières from 2008 to 2012 were reviewed, and cesarean delivery indications were coded into the same categories used by Timofeev et al. Location of project, age of patient, type of anesthesia, and duration of operation were recorded. RESULTS: The median age women undergoing cesarean delivery was 25 years, with 31 patients younger than 15 years and 2,253 (15%) aged 15–19 years. Most (11,207, 76.5%) procedures were performed under spinal analgesia. The mean time that the operating room was occupied for a cesarean delivery was 70 minutes. The most common indication for cesarean delivery was failure to progress or cephalopelvic disproportion (4,822, 30.3%), followed by previous uterine scar (2,504, 15.7%), nonreassuring fetal status (2,306, 14.5%) and fetal malpresentation (1,746, 11.0%). Other indications included placenta previa or vasa previa (794, 5.0%), uterine rupture (676, 4.3%), hypertensive disorders (659, 4.1%), placental abruption (520, 3.3%), prerupture (450, 2.8%), and cord prolapse (365, 2.3%). The frequencies differed significantly from the indications in the United States, where a previous uterine scar was the main indication for cesarean delivery. CONCLUSION: The case-mix of cesarean delivery indications differs significantly between the United States and humanitarian settings. This can assist those gynecologists aspiring to work in humanitarian settings.