Cesarean delivery is defined as the birth of a viable fetus(es) (≥500gm), placenta and membranes through incisions in the abdominal wall (laparotomy) and the uterine wall (hysterotomy).
This definition does not include removal of the fetus from the abdominal cavity in the case of rupture of the uterus or in the case of an abdominal pregnancy.
These are some of the Indications that could make a woman undergo cesarean section:
a) Previous cesarean - A repeat cesarean is indicated if;
- Previous cesarean was a classical cesarean (suffers uterine rupture prior to labor or if given a trial of labor)
- The previous uterine incision extended into the upper contractile portion of the myometrium
- Two prior cesareans
- The previous cesarean was indicated for labor arrest or dystocia
b) Dystocia or failure to progress in labor
c) Breech presentation - Fetuses presenting as a breech are at increased risk of cord prolapse and head entrapment if delivered vaginally compared with those presenting as a vertex.
d) Life threatening hemorrhage (APH)
e) Placenta praevia - Type IIb - IV
f) Contracted pelvis
g) Following repair of obstetric fistula (VVF)
h) Medical illness;
- severe HBP
- Cerebral aneurysm
- MSS disease
- Severe cardiac and respiratory disease
I) Pelvic tumors obstructing labor - fibroids, entrapped ovarian tumor, genital warts.
j) Maternal preference
a) Fetal distress.
b) Poor biophysical score
c) Malpresentation and malposition - breech, face, brow, compound, transverse lie, unstable/oblique lie.
d) Cord prolapse.
e) Macrosomia (>4kg).
f) Multiple pregnancies - 1st non cephalic, retained 2nd twin, extreme preterm, discordant fetal growth, single amniotic sac, conjoined twins, >2 fetuses.
g) Risk of infection - active HSV II, HPV, HIV, HBV
h) Fetal anomalies - hydrocephalus, sacral tumor
3. Due to Feto-maternal effects: APH - placenta praevia, vas praevia, abruptio placenta
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