What are the emergent and urgent indications for a cesarean section (CS)?

From the Guidelines

Emergent and urgent indications for cesarean delivery require prompt surgical intervention to prevent serious maternal or fetal harm, and the decision to perform an emergent versus urgent cesarean depends on the severity of the threat to maternal and fetal well-being, as seen in cases of umbilical cord prolapse, placental abruption with fetal distress, uterine rupture, and sustained fetal bradycardia 1. The most critical factor in determining the urgency of cesarean delivery is the severity of the threat to maternal and fetal well-being.

Key Indications for Emergent Cesarean Delivery

• Umbilical cord prolapse
• Placental abruption with fetal distress
• Uterine rupture
• Sustained fetal bradycardia These conditions require immediate attention and surgical intervention to prevent serious harm or death.

Key Indications for Urgent Cesarean Delivery

• Non-reassuring fetal status that is not immediately life-threatening
• Severe preeclampsia with deteriorating maternal condition
• Failed induction with maternal or fetal compromise
• Placenta previa with active bleeding
• Failed instrumental delivery
• Certain cases of malpresentation like transverse lie in active labor In these situations, the goal is to balance the risks of delaying delivery against the risks of hasty surgical intervention, with the primary goal being to prevent maternal and fetal morbidity and mortality. Preparation for cesarean delivery includes rapid assembly of the surgical team, expedited anesthesia (often general anesthesia for emergent cases), and immediate notification of neonatal resuscitation teams. It is essential to note that the presence of liver dysfunction and severe thrombocytopenia, as seen in HELLP syndrome, governs the choice of anesthetic and requires extensive preoperative preparation and invasive monitoring for successful management 1.

From the Research

Emergent Indications for Cesarean Section (CS)

• Fetal distress, which may require rapid delivery 2
• Breech position of the fetus 2

Urgent Indications for Cesarean Section (CS)

• Previous CS, which may increase the risk of complications in subsequent pregnancies 3
• Fetal distress, which may require immediate delivery 2
• Signs of infection during labor, which may increase the risk of surgical site infection 4

Other Factors that May Influence the Decision to Perform a CS

• Maternal request, which may be considered in the absence of medical indications 2
• Non-medical factors, such as convenience, lack of supervision and training, and absence of clinical guidelines 3
• Obstetric risk factors, such as older maternal age, nulliparity, and previous CS 3