title: A cross-sectional study of indications for cesarean deliveries in Médecins Sans Frontières facilities across 17 countries.
abstract: OBJECTIVE
  To review the major indications for cesareans performed by Médecins Sans Frontières (MSF) personnel from the Operational Center Brussels.
  
  
  METHODS
  A retrospective study was undertaken of all singleton cesarean deliveries from 2008-2012 for which indications were recorded. Location of project, age of patient, type of anesthesia, and duration of operation were also recorded.
  
  
  RESULTS
  A total of 14 151 singleton cesarean deliveries were identified from 17 countries. Among the 15 905 indications recorded, the most common was failure to progress or cephalopelvic disproportion (4822 [30.3%]), followed by previous uterine scar (2504 [15.7%]), non-reassuring fetal status (2306 [14.5%]), and fetal malpresentation (1746 [11.0%]). Other indications were placenta or vasa previa (794 [5.0%]), uterine rupture (676 [4.3%]), hypertensive disorders (659 [4.1%]), placental abruption (520 [3.3%]), pre-rupture (450 [2.8%]), and cord prolapse (365 [2.3%]).
  
  
  CONCLUSIONS
  Indications for cesareans in MSF settings differ from those in higher-income countries. Further investigation is needed for adequate emergency obstetric care coverage.
authors.affiliation: Surgeons OverSeas, New York, NY, USA; Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: rsgroen@hotmail.com.
authors.forename: Reinou S
authors.initials: RS
authors.lastname: Groen
authors.affiliation: Surgery, Anesthesia, Gynecology, and Emergency Medicine Unit, Médecins Sans Frontières (MSF), Operational Centre Brussels, Brussels, Belgium.
authors.forename: Miguel
authors.initials: M
authors.lastname: Trelles
authors.affiliation: Surgery, Anesthesia, Gynecology, and Emergency Medicine Unit, Médecins Sans Frontières (MSF), Operational Centre Brussels, Brussels, Belgium.
authors.forename: Severine
authors.initials: S
authors.lastname: Caluwaerts
authors.affiliation: Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada.
authors.forename: Jessica
authors.initials: J
authors.lastname: Papillon-Smith
authors.affiliation: MSF District Headquarters Hospital, Timegara, Pakistan.
authors.forename: Saiqa
authors.initials: S
authors.lastname: Noor
authors.affiliation: MSF Ahmad Shah Baba General Hospital, Kabul, Afghanistan.
authors.forename: Burhani
authors.initials: B
authors.lastname: Qudsia
authors.affiliation: MSF Obstetric Emergency Centre of Kabezi, Kabezi, Rural Bujumbura Province, Burundi.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Ndelema
authors.affiliation: MSF Referral General Hospital, Dakoro, Niger.
authors.forename: Kalla M
authors.initials: KM
authors.lastname: Kondo
authors.affiliation: Surgeons OverSeas, New York, NY, USA; Centre for Global Surgery, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Evan G
authors.initials: EG
authors.lastname: Wong
authors.affiliation: James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Hiten D
authors.initials: HD
authors.lastname: Patel
authors.affiliation: Surgeons OverSeas, New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
mesh_terms: D000037:Abruptio Placentae / Q000601:surgery; D000293:Adolescent; D000328:Adult; D052178:Cephalopelvic Disproportion / Q000601:surgery; D002585:Cesarean Section / Q000706:statistics & numerical data*; D002921:Cicatrix / Q000601:surgery; D003430:Cross-Sectional Studies; D004420:Dystocia / Q000601:surgery; D005260:Female; D005316:Fetal Distress / Q000601:surgery*; D006801:Humans; D007390:International Agencies / Q000706:statistics & numerical data*; D007746:Labor Presentation; D008507:Medically Underserved Area; D007744:Obstetric Labor Complications / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D014591:Uterine Diseases / Q000601:surgery; D014597:Uterine Rupture / Q000601:surgery; D055815:Young Adult
keywords: Cesarean delivery; Doctors Without Borders; Global surgery; Indications; Maternal health; Médecins Sans Frontières; Obstetrics