[Indications and prognosis of cesarean section at Befelatanana maternity unit--Central University Hospital of Antananarivo (apropos of 529 cases, during the year 1998)].

High maternal mortality rate (12 death per 1,000 births, in 1997) has suggested this study in order to improve cesarean's management, then to reduce maternal death. Therefore, during the year 1998, 529 women among 8,366 had cesareans, which are 6.8%. The epidemiological profile reveal evacuation (82.4% of the cases); their average age is 29 years old and the average parity were 3. Principal indications are: dystocia (26.8%), fetal distress (38.1%), dynamic dystocia, previous uterine incision (11.2%). Maternal prognosis is mediocre because of a high mortality rate (2% of cesarean) and an important morbidity related to infection (29.5%). The same things happens with fetal prognosis. Classifications of indications to cesarean in 3 categories according to priorities help to plan and appreciate management of cesarean in a rational way. The reason why cesareans had to be a compulsory (42% of our cases) is to reduce maternal mortality. Cesarean as precautions (51.2%) and cesarean as needs (3.9%) were decided because of a bad surveillance of pregnancy and birth. In fact in order to reduce the maternal death with indication of cesareans, National Health System has to increase surgical structures with appropriate equipment and medicine, held by competent and sufficient number of staff. The female condition must be improved and population should be aware that they need to come to birth places and participate to the health care's cost.