**Abstract**

Caesarean section (CS) refers to delivery of a foetus through surgical incisions made through abdominal and uterine walls. It's a life-saving procedure when complications arise during pregnancy. It may be an emergency or a planned procedure. Although desirable, CS may be medically unnecessary. CS is a major procedure associated with immediate and long-term maternal and perinatal risks and may have implications for future pregnancies. Since 1985, international healthcare community considers ideal rate for CS to be 10–15%. However, in the last decade, there has been concern about the rising rates of CS from as low as 2% in Africa to as high as 50–60% in Dominican Republic and Latin America. To this effect, there have been attempts to regulate the rates, and the Ten Group Classification System under the Robson criteria is such an attempt. CS rates are on the increase due to varying reasons ranging from patient, institutional, care provider and societal factors. There have been modifications in the CS technique and the drugs used postoperatively from Pitocin to addition of Misoprostol. Need has developed from Reproductive Health Specialists to review indications, rates and terminologies used and evaluate practices in low-, middle- and high-income countries regarding CS.

**Keywords:** caesarean section, rates, LMICs

## **1. Definition**

Caesarean delivery commonly referred to as caesarean section and occasionally caesarean birth is defined as the delivery of a foetus(es) through surgical incisions made through the anterior abdominal wall (technically referred to as laparotomy) and the anterior uterine wall (technically denoted to as hysterotomy) [1, 2]. This definition considers only the intrauterine location of the foetus and not whether the foetus is delivered alive or dead [3]. Since the words "caesarean" and "section" are both derived from verbs that mean to cut, some authors [1] urge that the phrase "caesarean section" is a tautology. Consequently, the terms "caesarean delivery" and "caesarean birth" are preferable.

Although infrequent, there are reports of foetal survival from advanced abdominal pregnancies resulting into live birth [4]. The procedure for delivery of such foetus(es) is not caesarean section but rather laparotomy. It is technically challenging to assign the type of procedure carried when simultaneous abdominal and intrauterine pregnancy is encountered [5]. Considering the definitions above, it would be urged that the procedure is caesarean section for the intrauterine foetus and laparotomy for the abdominal pregnancy. However, laparotomy alone would suffice. Confusion also arises among medical students when a foetus before the age of viability has to be delivered through abdominal surgery. Most obstetricians and gynaecologists refer to this procedure as hysterotomy rather than caesarean section.
