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Indications for cesarean section

 

Cesarean section can and is performed for a whole variety of reasons. Some indications are the mother’s (maternal) and others are baby’s (fetal). Very occasionally, it is because of issues to bo with both. Listed below are some of the more common maternal indications.

Ø Maternal pelvis: if the birth canal is deemed too narrow to allow safe passage of the baby, a cesarean section will be the only option. This state of affairs may be recognized following previous experience such as labour that was very difficult or that never progressed beyond a certain point. In such a case the cesarean section will be planned electively. It may otherwise be discovered in the course of labour and cesarean section is resorted to.

Ø Previous cesarean section: In the United States, less than 10% of women with previous cesarean section have a vaginal delivery. Figures in Europe and other parts of the world are a lot higher. Previous cesarean delivery is not always an indication for repeat cesarean section, except in a situation where the reasons for the previous cesarean section are still there, such as a narrow pelvis.

Ø Medical conditions: Presence of serious medical conditions such as heart failure or serious respiratory conditions is sometimes deemed an indication for cesarean delivery in order to circumvent the stresses and strains of labor. More often, instrumental (vaginal) delivery in the form of forceps or ventouse is opted for.

Ø Abnormal placental position: A low-lying placenta (a condition known as "placenta previa") is an indication for cesarean delivery.

Ø Placental abruption: If the placenta detaches partially or wholly during pregnancy or labour, emergency cesarean section may be performed, especially if there is hope of saving the baby.

Ø Previous plastic or corrective surgery to the vagina: If childbirth risks undoing the previous surgery, then the only way of getting around this problem is to perform a cesarean section.

Ø Failure to progress in labour: if labour appears to be getting nowhere in spite of everything, abdominal delivery may be the only option.

 

Fetal indications for cesarean section

 

Ø Fetal distress is the most common fetal indication for cesarean section. This may be perceived or confirmed. The tendency is to err on the side of safety.

Ø Breech presentation: When breech is the leading part of the baby, there is a high likelihood of cesarean section. A small minority of breech-presenting babies are delivered vaginally.

Ø Multiple pregnancy: A significant proportion of twins are delivered by cesarean section. This is usually because the first twin is presenting with a part other than the head. It could also be performed because one or both twins' well­being is causing concern. Virtually all high-order multiple pregnancies (triplets and so forth) are delivered by cesarean section.

Ø Abnormal lie: It is not only breech which is the positional indication for cesarean section. Sometimes the baby is found in a ‘transverse’ or oblique lie, where the fetus is lying across so the head is on one side and the bottom on the other. This is incompatible with vaginal delivery and a cesarean section will need to be done if the mother is in labor. If she is not, an expectant management is adopted, with hope that the baby will assume a favorable position.

Ø Cord prolapse: If the ‘waters’ break in early or mid-labor and the umbilical cord prolapses, a cesarean delivery is the only option.

 

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