Indications for Caesarean Section
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Direct answer
Caesarean section delivers the fetus through abdominal and uterine incisions, today usually a lower segment caesarean section (LSCS). Indications are maternal (previous two caesareans, severe pre-eclampsia, obstructed labour), fetal (non-reassuring fetal status, malpresentation, cord prolapse) or mechanical (contracted pelvis, placenta praevia of major degree, obstructing tumours). The decision weighs vaginal-birth risk against surgical risk, with an urgency classification driving timing.
What you must remember
- Common indications — previous two or more caesareans (or one with unfavourable factors), cephalopelvic disproportion and obstructed labour, failed induction, non-reassuring fetal heart traces, transverse lie and persistent breech in a primigravida.
- Further indications — major placenta praevia, abruptio placentae with fetal compromise, cord prolapse, twins with the first twin non-vertex, eclampsia with an unfavourable cervix, active primary genital herpes, untreated HIV with a high viral load, and previous classical caesarean or myomectomy entering the cavity.
- The lower segment incision heals strongly with a lower risk of rupture in future pregnancies; a classical (upper segment) incision is reserved for very early gestations, transverse lie or an inaccessible lower segment, and mandates elective caesarean thereafter.
- Urgency categories in common use — category 1 means immediate threat to the life of mother or baby, with delivery aimed for within about 30 minutes of decision; category 4 is planned elective surgery.
- Trial of labour after caesarean (VBAC) suits a woman with one previous lower segment caesarean, a non-recurrent indication and spontaneous labour; uterine rupture risk is below 1 per cent.
- Every caesarean carries risks — haemorrhage, infection, thromboembolism, anaesthetic complications and placenta accreta spectrum in later pregnancies — so a documented indication and consent are mandatory.
Common confusion
Absolute and relative indications are routinely jumbled. An absolute indication, such as a contracted pelvis with a viable fetus or major placenta praevia, rules out vaginal delivery altogether; a relative indication, such as one previous caesarean or mild growth restriction, tips the balance towards surgery. Similarly, "previous one caesarean" is not an automatic indication — a well-selected woman may attempt VBAC, whereas two previous caesareans generally are.
Exam-focused takeaway
Vignettes give a clinical scenario and ask for the mode or timing of delivery — learn the indication list by maternal, fetal and mechanical groups. Category-1 timing, classical-versus-lower-segment implications for future births, and VBAC selection criteria with the below-1-per-cent rupture figure are the recurring stems, along with placenta accreta spectrum after repeated caesareans.
Frequently asked questions
What are the common indications for caesarean section?
Previous two or more caesareans, cephalopelvic disproportion or obstructed labour, failed induction, non-reassuring fetal status, malpresentations such as transverse lie, major placenta praevia and cord prolapse.
What is a category 1 caesarean section?
The most urgent category — immediate threat to the life of the mother or baby, such as cord prolapse or placental abruption — with delivery targeted as soon as possible, commonly within about 30 minutes.
Which women can attempt VBAC?
Those with one previous lower segment caesarean, a non-recurrent indication, spontaneous labour and facilities for immediate surgery. Uterine rupture risk is below 1 per cent.
Why is the lower segment incision preferred?
It is relatively avascular, heals better and ruptures less often in later pregnancies, allowing a trial of labour; the classical incision always requires elective repeat surgery.
What are the risks of caesarean section?
Haemorrhage, infection, thromboembolism, anaesthetic complications, longer recovery, and future placental problems including accreta spectrum.