The average age of patients was 27.64 years, with a range from 14 to 47 years. The most common age group was 20 to 34 years.

The majority of our respondents resided in the municipalities of Abomey-Calavi (43.50%) and Cotonou (26.57%). Those with at least a secondary education represented 42.89%, and most were married (69.64%).

Paucigest and nulliparous women were the most represented with respective proportions of 35.50% and 38.07%. Hypertension and caesarean section were the most common medical history. Regarding pregnancy monitoring, it was good in 45.86% with at least 04 prenatal consultation and more than 4/5 (80.36%) had carried out a minimum prenatal labtest. Midwives were the agents who monitored the pregnancy in most cases.

The majority of pregnant women were referred (80.43%), without medical transport (56.57%). The reasons for referral were dominated by hypertension associated to pregnancy (39.47%), fetal distress (15.17%), and third-trimester hemorrhage (12.77%). On admission, the general condition was good in 72.36% of cases. Pregnancies were singleton (92.36%), preterm (52.35%), cephalic presentation (90.58%), in a clinically normal pelvis (79.21%).

The indication for cesarean section was made by a resident in 86.79% of cases before being confirmed or denied by the senior physician. The main indications found were third-trimester hemorrhage (36.09%), acute fetal distress (35.49%), and severe preeclampsia (21.84%). Regional anesthesia was performed in 70.50% of cases.

The average time to completion was 114 minutes. Average times per indication ranged from 22 minutes (prolapsed umbilical cord) to 158 minutes (placenta previa), as shown in Table 1 .

Of the 1507 newborns, 316, or 20.97%, underwent neonatal resuscitation. The APGAR score was superior to 8 in most cases. Neonatal mortality was estimated at 11.35%.

The longer the ceasean section delivery time, the higher the neonatal morbidity and mortality ( Figure 1 and Table 2 ).

The longer the Ceasean section delivery time, the higher the maternal morbidity and mortality ( Table 3 ).

The average age of patients was 27.64 years, with a range from 14 to 47 years. The most represented age group was 20 to 34 years. This age group represents the peak fertility rate. These results are comparable to those of Anihouvi et al. (28 years) in 2019 in the same department [4] . The majority of subjects in our study resided in Abomey-Calavi (43.05%). Maikolyang, however, reported in 2015 that more than half of the patients at the CUGO came from Cotonou (68%) [7] . This reflects the dormitory town character of the municipality of Abomey-Calavi. Furthermore, many patients were referred from the Abomey-Calavi University Hospital to CUGO.

The majority of patients in our study were married (69.64%). This rate is significantly higher than that of Anihouvi [4] and al. in 2019 (35.33%) and that of Essiben and al. in Yaoundé in Cameroon which reported 34.1% of brides [8] .

Paucigestes (35.5%) and nulliparous women (38.07%) were the most represented in our study. Other African authors, including Fouelifack and al. reported a high rate of nulliparous women (35.9%) [5] . Furthermore, 17.95% of the subjects surveyed had a history of cesarean section. This proportion is lower than that of Anihouvi and al. in whom they represented 30.67% [4] . Nearly half of the patients in our series (45.86%) had good pregnancy monitoring with at least 4 prenatal consultation. As for prenatal assessment, 80.36% had a minimum of prenatal assessment while 14.43% of them had no assessment. This raises the problem of financial accessibility to obstetric care in Africa in general.

Hypertension associated to pregnancy appeared to be the leading cause of emergency cesarean sections at CUGO, accounting for 36.09% of indications. This was followed by acute fetal distress (35.49%) and third-trimester hemorrhage (17.24%). According to the World Health Organization (WHO), 16% of maternal deaths in sub-Saharan Africa are due to hypertensive disorders during pregnancy, with preeclampsia (PE) and eclampsia being the leading causes [9] . Several factors have been implicated, including advanced age of pregnant women, multiple pregnancies, nulliparity, a personal history of PE, and a history of chronic hypertension, type 2 diabetes, or renal failure [10] - [13] . Also, studies suggest that modifiable factors such as obesity, hypertriglyceridemia, smoking and diabetes may be added [14] - [16] .

The average decision-to-incision time in our study was 114 minutes, beyond the 93 minutes reported by Anihouvi in 2019 and below the 124 minutes reported by Mongbo and al. in 2012 [17] . The increase in this time compared to Anihouvi’s study in 2019 could be explained by the increasing number of admissions to CUGO, an increase not compensated by a strengthening of staff and infrastructure, particularly operating rooms [4] . This time is important because it has a medico-legal value. Experts and judges often use it to assess the efficiency of a team, recommendations from foreign learned societies, by examining the time between the decision to perform a cesarean section and the birth of the child [18] . This is why it is recommended in the United States and Great Britain that this time limit should not exceed 30 minutes and 20 minutes in Germany [19] [20] . It is clear that the operating conditions of obstetric services in Africa are far from allowing their staff to achieve such performance.

The longer the delay in treatment, the higher the maternal and fetal morbidity and mortality. Thus, it increased from 38.33% for delays < 1 hour to 66.84% for delays > 4 hours for maternal morbidity and mortality. Mbongo JA and al., after a study at the Brazzaville University Hospital in 2016, stated that the delay between the indication and the performance of cesarean section is a factor that worsens maternal prognosis [17] . However, Anihouvi and al., in 2019, did not find a correlation between the delay in treatment and maternal and fetal prognosis [4] . Fouelifack and al., concurred regarding maternal prognosis, but regarding fetal prognosis,

They found that perinatal complications increased significantly when the time to treatment was greater than 120 minutes [5] .

The maternal mortality rate among parturients in our series was 1.35%, significantly lower than the 5.33% reported by Anihouvi in 2019 [4] , with a continuing downward trend over the three years of our study. Indeed, it was 2.42% in 2021, 1.25% in 2022, and 0.73% in 2023. This could be explained by measures such as subsidizing caesarean sections, better availability of labile blood products… demonstrating the ongoing efforts at all levels to reduce maternal mortality. Other studies conducted in sub-Saharan African countries have found similar rates: this is the case in Cameroon (3.3%) according to the report by Batoum and al. in 2022 [21] . Of the 1507 newborns resulting from emergency caesareans, 171 deaths were recorded, representing a perinatal mortality of 11.34%, below the 14.94% of the Ahinouvi study in 2019. Batoum and al in 2022 in Yaoundé reported a perinatal mortality of 15% [21] . But in the countryside (Maroua in Cameroon), Mboua Batoum found a much higher perinatal mortality of 21.6% with a strong correlation between the time to intervention and the fetal prognosis [21] .