Operative Vaginal Delivery in Modern Obstetrics: Evidence, Practice, and Controversies

Cesarean section (CS) delivery is a procedure with increasing global prevalence, particularly in Egypt, where rates have reached 52% of all deliveries. Indications for Cesarean section are categorized as maternal indications (prior Cesarean section), uterine or anatomic causes (abnormal placentation, prior classical hysterotomy), and fetal indications (nonreassuring status, malpresentation). Despite its necessity in certain scenarios, Cesarean section significantly increases maternal mortality (6–22 deaths per 100,000 births) and morbidity through intraoperative and postoperative complications. Egypt's exceptionally high Cesarean section rates stem from absent national guidelines, inadequate antenatal education, financial incentives favoring surgical delivery, and widespread patient misconceptions. Studies reveal alarming statistics: 19% of Egyptian women surveyed were unaware of their Cesarean section indication, only thirty-three percent received information from healthcare providers, and 47.2% underwent general anesthesia despite safer alternatives. These findings highlight the urgent need for evidence-based guidelines, improved patient education, and standardized practices to address this critical public health issue.