Background: Caesarean section (CS) rates increased nowadays all over the world. This increase raises the concern of un-necessary CS that increases maternal and fetal morbidity and mortality. Objective: This study aimed to assess the rates, the indications of caesarean delivery and to find out why the rates are continuously increasing at a tertiary health care hospital in Egypt. Methods: A prospective observational design was selected for this research. A cohort of 750 hospital deliveries were prospectively fol- lowed up intra-partum in the obstetric unit of Mansoura university hospital (MUH).Cases' history, labor anddelivery events were pro- spectively recorded bythe study team who just observed provided no intervention. Results: an overall CS rate of 65.2% (489/750) was recorded in this cohort, vaginal delivery in the remaining (34.8%). Most CS were antepartum 59.1% (289/489) vs. (40.9%) intra-partum and those done intra-partum were mostly in the latent phase 78% (156/200) vs. (22%) in the active phase .This high CS rate (65.2%) has sig- nificantly exceeded the previous CS rate published from the same unit in 2013 47.25% (16348/34598). Compared with the previous study published from the same unit the CS rate increased significant- ly: odds ratio & 95% CI is 2.092 (1.797 to 2.434). Relative Risk & 95% CI is 1.380 (1.308 to 1.456, P<0.0001). Although we found no significant differences in maternal and neonatal morbidity and mor- tality between vaginal and CS deliveries in this study (probably due to small sized cohort) .The risks of maternal and neonatal morbidity has been emphasized in larger studies. Conclusion: The study concluded that CS rates in our hospital has significantly increased in the last few years which implies increased risks to the mother and neonate and also imply a burden on the forecoming pregnancy(ies).