# Indications for Caesarean Section

> NEET-PG OBG notes on indications for caesarean section covering fetal, maternal and mechanical causes with VBAC selection and exam points.

- Canonical URL: https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/indications-for-caesarean-section
- Exam / course: NEET-PG · Subject: Obstetrics and Gynaecology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Indications for Caesarean Section", PrepElephant, https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/indications-for-caesarean-section

## 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.