Caesarean Section - Indications

Indications

Caesarean section is recommended when vaginal delivery might pose a risk to the mother or baby. Not all of the listed conditions represent a mandatory indication, and in many cases the obstetrician must use discretion to decide whether a Caesarean is necessary. Some indications for Caesarean delivery are:

Complications of labor and factors impeding vaginal delivery, such as:

  • prolonged labour or a failure to progress (dystocia)
  • fetal distress
  • cord prolapse
  • uterine rupture
  • increased blood pressure (hypertension) in the mother or baby after amniotic rupture
  • increased heart rate (tachycardia) in the mother or baby after amniotic rupture
  • placental problems (placenta praevia, placental abruption or placenta accreta)
  • abnormal presentation (breech or transverse positions)
  • failed labour induction
  • failed instrumental delivery (by forceps or ventouse (Sometimes a trial of forceps/ventouse delivery is attempted, and if unsuccessful, it will be switched to a Caesarean section.)
  • large baby weighing >4000g (macrosomia)
  • umbilical cord abnormalities (vasa previa, multilobate including bilobate and succenturiate-lobed placentas, velamentous insertion)

Other complications of pregnancy, pre-existing conditions and concomitant disease, such as:

  • pre-eclampsia
  • hypertension
  • multiple births
  • previous (high risk) fetus
  • HIV infection of the mother
  • Sexually transmitted infections, such as genital herpes (which can be passed on to the baby if the baby is born vaginally, but can usually be treated in with medication and do not require a Caesarean section)
  • previous transverse Caesarean section
  • previous uterine rupture
  • prior problems with the healing of the perineum (from previous childbirth or Crohn's disease)
  • Bicornuate uterus
  • Rare cases of posthumous birth after the death of the mother

Other

  • Lack of obstetric skill - obstetricians not being skilled in performing breech births, multiple births, etc. (In most situations, women can birth vaginally under these circumstances. However, obstetricians are not always trained in proper procedures)
  • Improper Use of Technology (Electric Fetal Monitoring )

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