Background: Cesarean sections (c-sections), the most common surgical procedures performed worldwide, are essential in reducing maternal and neonatal deaths. There is a paucity of research studies on c-section care and outcomes in rural African settings. The objective of this study was to describe demographic characteristics, clinical management, and maternal and neonatal outcomes among women receiving c-sections at Kirehe District Hospital (KDH) in rural Rwanda. Methods: This retrospective cohort study included all women aged 18 y residing in KDH catchment area who delivered by c-section at KDH between April 1 and September 30, 2017. Demographic and clinical characteristics of these women and their newborns were collected using patient interviews and medical chart extraction. Descriptive analyses were performed, and frequency and percentages are reported. Results: Of the 621 women included in the study, 45.7% (n ¼ 284) were aged 25-34 y; 42.2% (n ¼ 262) were married; 67.5% (n ¼ 419) had primary education; and 75.7% (n ¼ 470) were farmers by occupation. Burundian refugees living in the nearby Mahama Refugee Camp comprised 13.7% (n ¼ 85) of the study population. The most common indication for csection was having undergone a c-section previously (31.9%, n ¼ 198), followed by acute fetal distress (30.8%, n ¼ 191). Among those with previous c-section as the sole indication for surgery, 85.4% presented as either urgent or emergent cases. Postoperatively, 67.7%
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