Background With up to 20% of our patients being delivered by elective caesarean section we conducted a review to determine the main indications in order to highlight potential areas for intervention to reduce the rate.

Method This was a prospective review over a period of eight weeks. Data was collected from patient notes on the day of surgery.

Results A total of 102 cases were reviewed. In 68 the indication was previous caesarean, 49 of which had undergone a single previous caesarean. Thirteen of the 49 had no documented counselling for trial of vaginal delivery.

Maternal request accounted for 11 cases, most of which were in primiparous women. The remaining indications included breech presentation, previous 3^rd/4^th degree tear, previous shoulder dystocia, placenta praevia and multiple pregnancy.

In 27 cases delivery was before 39 weeks gestation. Of these 5 were in diabetic patients and 3 were twin pregnancies.

Discussion and conclusions Almost half the caesareans were performed on women who may have been suitable for a trial of vaginal delivery. It is possible that more counselling or a specialist clinic could increase the vaginal delivery rate.

Whilst they made up 10% of the cases, the majority of caesareans done for maternal request had clinically justified indications.

The unexpected finding that a quarter of deliveries were under 39 wks has significant implications in terms of neonatal morbidity and a review of this is planned.