Objective: To analyze changes in frequency of caesarean section in the Czech Republic during period 1978 - 1997. Design: Descriptive epidemiology Methods, Results, Discussion, Conclusion: The total cohort of all maternal deaths was analyzed regarding the main causes of death and the mode of delivery. Since 1978, a systematic analysis of individual cases of maternal deaths has been performed, in terms of their causes, course and avertabiliy (446 direct, specific and indirect, unspecific deaths). Thromboemboly, which was the main cause of maternal mortality until 1993, factually ceased to occur in the last four years. Currently, hemorrhage is rated as the 2nd cause, followed by cardiovascular - and further post- surgical complications, toxicosis, infections etc. In 34% of all cases in the period beginning from 1978, we strictly stated inadequate medical procedures. These cases are analyzed at medical fora and, subsequently, disclosed and published, anonymously. The increase in the number of caesare- an sections from 3,5% to 11,9% in the course of years 1978 to 1997 presents a remarkable share of maternal mortality in the CR. While the share of intra- and postnatal deaths in connection with CS was 44% in 1978 - 1990, in the years 1991 - 1997 it increased to 61%. Out of which, the number of deaths in direct relation with surgery increased from 22 to 29%. By means of nation-wide enforced prophylactics of tromboembolia and DIC, the lethality in direct relation with CS was reduced from 0,44‰ in the years 1988-90 down to 0,24‰ in the years 1991-97. Total lethality 0,49‰ in the last five years is 4,4 times higher than after a total number of deliveries, which is the main argument against further unreasonable growth of CS, and for improvement of general surgical conditions in the nation wide perspective.

        Key words: caesarean section, maternal death, lethality