This study reviews cesarean sections done at Kasr AlAini Obstetrics and Gynecology hospital which represents a major national and regional referral center. This helps to take a representative sample of all possible patient presentations. In addition being a teaching hospital guarantees the use of a respectable protocol of management away of individual practitioner attitudes. Objective: Evaluation of performance toward cesarean section in Kasr Al Aini Obstetrics and Gynecology hospital in an attempt to define the causes of the increased cesarean rate and how to manage. In addition, the study evaluates the threshold concerning the decision to perform a cesarean section, the rate of each indication and how much the concept of VBAC is adopted at kasr Al Aini Hospital. Methodology: The study was conducted in Kasr El Eini Obstetrics and Gynecology hospital. Records of women who underwent cesarean sections at the emergency department from the 1st of May 2010 to the 31st of May 2011 were retrospectively reviewed. Which takes into account characteristics such as age, parity, period of gestation, labour status, indication of cesarean delivery, comorbidities, complications and mortality. Collected data were used in a descriptive design to provide numerical summaries of different parameters. Results: Cesarean deliveries were performed with an incidence of 39.03%. Repeat cesarean section is the main indication with an incidence of 46%), followed by reasons related to intra- partum status (15%) such as fetal distress (7.4%) & failure of progress (7.2%). Conclusion: The incidence of cesarean section in Kasr El Eini Obstetrics and Gynecology hospital is markedly increased over the time period from 1997 (21.86%) to 2011 (39.03%). The most common indications were repeat cesarean, dystocia, non-reassuring fetal condition and breech presentation. Repeat cesarean is the major indication. The safety of cesarean section is relatively increased