During the study period, 595 caesarean sections were performed out of a total of 4410 deliveries, a rate of 13.5%.

The average age of our patients was 27 years old with extremes of 13 and 45 years old. They were married in the majority of cases (98.2%) and resided in Dakar and its suburbs (98.3%). The average parity was 2 with extremes of 0 and 12. The patients were admitted with a uterus-cicatricial in 28.4% of cases and bi-cicatriciel in 25.4% of cases. Prenatal follow-up was considered acceptable in 60.6% of the cases, i.e. at least 3 prenatal consultations and a complete biological assessment.

The patients were evacuated in 45% were evacuated (referred in 29.7 and evacuated in 15.3%). They came mainly from health posts (48.1%), level I health centers (40.7%). In 11.2% of cases, patients were transferred by other Level II Health Centers. Pregnancy was 478 patients, or 80.3% of the sample. Gestational age was estimated at less than 37 weeks of amenorrhea in 109 patients (18.3%) and greater than 42 weeks in 8 patients (1.4%). A pathology was associated with pregnancy in 31.6% of cases. These conditions were dominated by vascular-renal syndromes (75.5%), anemia (13.8%) and barriers previa (uterine fibroids or placenta previa) (10.1%).

Caesareans were performed urgently in 517 patients (86.9%) and programmed in 78 of them (13.1%). Of the patients operated on an emergency basis, the 26 (4.36%) were initially scheduled but were admitted before the date fixed for cesarean section. The indications according to Maillet’s analytical classification are shown in Figure 1. About half of the Caesarean sections were cautious and only 1/3 of the Caesareans were mandatory.

The time between the caesarean section decision and the fetus extraction (decision-birth) exceeded one hour in more than half of the cases (58%). Figure 2 shows the distribution of patients by the time between caesarean section decision and fetal extraction. Most patients had had locoregional anesthesia (90.40%). Joël Cohen’s incision in the Migav Ladach technique was the most frequently used (75.1%); the medial sub-umbilical incision is reserved for patients who already have this type of scar (6.9%). The hysterotomy was transverse and arcuate segmental in 93.28% of cases.

1) Maternal

The average hospital stay was 4.2 days with extremes of 0 and 15 days. Postoperative

maternal mortality was 0.34%. Operative follow-up was simple in 98.3% of patients. Two patients (0.34%) died after surgery (Table 1).

2) Fetal and neonatal

In 92.4% of the cases, the newborns were alive. The Apgar score in the first minute was favorable (greater than or equal to 7/10) in 503 newborns (95.1%) and unfavorable (less than 7/10) in 47 cases (8.55%). At the fifth minute, he was favorable in 98.5% of the cases. Overall stillbirth was 72.26 ‰ with a total of 43 stillbirths including 3 macerated stillbirths. Birthweight was normal in 421 neonates (70.8%), ranging from 2500 to 4000 grams. Thirty-three (5.5%) newborns were macrosomes and 141 (23.7%) were small.

The condition of the newborn was not dependent on the delay between the decision of a caesarean section and its completion. On the other hand, the analysis showed that it was strongly related to the context. The Apgar score was poor as caesarean section was performed urgently (Table 2 and Table 3).

During the recruitment period, seventy-eight scheduled cesareans were performed and no complications were noted. However, five hundred and seven caesareans were performed urgently and ten patients had complications (endometritis, parietal suppuration, suture release and two deaths were recorded). But there was no statistically significant difference (p = 0.909).

Caesarean section rates are variously reported in the literature. However, they do

not appear to be related to the level of development of countries [3] [4] [5] . This rate reached 40% in 2006 in Brazil [5] . Our caesarean section rate of 13.49% is similar to that reported by Bambara in Burkina Faso, which was 11.33% in 2000. It is lower than that found by Cissé and Bobassa who were respectively 25.2% and 31% [6] . This rate of caesarean section although not representative of the entire population of Dakar or Senegal, remains in the proportion of intervention recommended by the World Health Organization in 1985 (between 10% and 15%) [7] . And since this WHO report, all practitioners are committed to keeping rates below 15%. It is also known that in the absence of any complication and any pathological history, at least 6% to 8% of patients will undergo a caesarean section during labor.

The age group between 20 and 24 years was the most affected by caesareans. Cissé [8] finds the same age range as our study. The more we go to developed countries, the higher the age. This can be explained by the advanced age of patients in developed countries. In developing countries, young age can be explained by early union and low contraceptive prevalence as is the case in Senegal [9] . In developed countries, it is a much older population [10] .

Parity in our study ranged from 0 to 12 with an average of 2.5, with a higher proportion of primiparae (41.5%). Several African authors [11] [12] have found similar results. A survey in France in 2010, in addition to the increase in rates since 1990, also found a slight increase in caesareans for primiparous women (23 to 23.2%). As for multiparas, those with a history of Caesarean section were more likely to be scheduled or unplanned [13] .