Trends in caesarean section rates and stillbirths at a senegalese referral maternity hospital, 2020-2025

Caesarean section is essential when medically indicated, but rising use should be interpreted according to the obstetric profile of individual facilities. We assessed concurrent trends in caesarean section use and stillbirths at a referral maternity hospital in suburban Dakar, Senegal. This retrospective analytical study included deliveries recorded at Centre Hospitalier National de Pikine from 1 January 2020 to 31 December 2025. Caesarean section rates were calculated among deliveries with a documented mode of birth. To avoid mismatch between pregnancies and fetuses, the primary stillbirth analysis was restricted to singleton pregnancies with documented fetal status. Trends were assessed using logistic regression, and associated factors were estimated using adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Among 22,682 deliveries, 9,662 caesarean sections were recorded (42.8%). The rate increased from 37.5% in 2020 to 47.7% in 2025 (P for trend <0.001). Among 20,898 eligible singleton births, 1,134 stillbirths occurred (54.3 per 1,000). The rate declined from 58.7 per 1,000 in 2020 to 41.7 per 1,000 in 2025, with a peak of 80.0 per 1,000 in 2022 (P for trend <0.001). Caesarean delivery was associated with obstetric referral, non-cephalic presentation, placental abruption, placenta praevia, severe pre-eclampsia, and fetal growth restriction. Stillbirth was associated with fewer than four antenatal visits (aOR 2.97; 95% CI 2.56-3.43), obstetric referral (aOR 2.03; 95% CI 1.76-2.34), placental abruption (aOR 9.85; 95% CI 7.98-12.15), and prematurity (aOR 4.02; 95% CI 3.43-4.70). Caesarean section use increased while hospital stillbirths declined overall, but these concurrent trends do not establish causality. Standardised audits of caesarean indications, stillbirths, and referral pathways are warranted.