From the Guidelines
The top 10 main indications for cesarean delivery include fetal distress, failure to progress in labor, cephalopelvic disproportion, abnormal fetal presentation, placental issues, maternal medical conditions, prior cesarean delivery, multiple gestation, active genital herpes, and umbilical cord prolapse. These indications are based on the need to prioritize the health and safety of both the mother and the baby, reducing the risk of morbidity, mortality, and improving quality of life.
Key Indications for Cesarean Delivery
- Fetal distress, which can be detected through abnormal heart rate patterns on monitoring 1
- Failure to progress in labor, where labor stalls despite adequate contractions
- Cephalopelvic disproportion, where the baby's head is too large to safely pass through the mother's pelvis
- Abnormal fetal presentation, such as breech position, which can increase the risk of birth trauma
- Placental issues, including placenta previa and placental abruption, which can cause dangerous bleeding
- Maternal medical conditions, such as severe preeclampsia, active herpes infection, or HIV with high viral load, which may require cesarean to protect mother and baby
- Prior cesarean delivery, which can increase the risk of uterine rupture, though vaginal birth after cesarean (VBAC) may be possible in select cases
- Multiple gestation, especially with three or more fetuses, which often requires cesarean delivery
- Active genital herpes, which can increase the risk of transmission to the baby
- Umbilical cord prolapse, an emergency where the cord precedes the baby, requiring immediate cesarean to prevent oxygen deprivation
Considerations for Cesarean Delivery
In cases where the fetus is potentially treatable or considered viable, cesarean delivery may be indicated, especially if antepartum surveillance or expert concern about deterioration of the fetal condition suggests the need for immediate delivery 1. Additionally, consideration should be given to whether drainage of a large effusion may improve the efficacy of neonatal resuscitative efforts, and whether effusions may pose a risk for trauma to the infant during delivery. However, if a decision has been made not to intervene for fetal indications and to provide comfort care only, vaginal delivery is preferred unless otherwise contraindicated 1.
Prioritizing Health and Safety
Ultimately, the decision to perform a cesarean delivery should be based on the individual circumstances of each case, prioritizing the health and safety of both the mother and the baby, and reducing the risk of morbidity, mortality, and improving quality of life 1.
From the Research
Main Indications for Caesarean (C-Section) Delivery
The main indications for Caesarean delivery can be categorized into several key areas, including:
- Maternal indications
- Fetal indications
- Obstetrical indications
Maternal Indications
Maternal indications for Caesarean delivery include:
- Human immunodeficiency virus (with high viral load) 2
- Herpes simplex virus (with active lesions) 2
- Hypertensive disorders 3
- Previous uterine scar 3
- Maternal hemorrhage from previa or trauma 4
Fetal Indications
Fetal indications for Caesarean delivery include:
- Abnormal fetal heart rate patterns in labor 5, 6
- Fetal malpresentation 5, 3, 6
- Fetal macrosomia 5, 6
- Multiple gestation 5, 3, 6
- Functional and structural fetal abnormalities 6
- Non-reassuring fetal status 3
Obstetrical Indications
Obstetrical indications for Caesarean delivery include: