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Caesarean Section

Extracted from Survival Guide to Midwifery, 2nd Edition (2012) Diane M. Fraser and Margaret A. Cooper, Oxford; Churchill Livingstone: 2012. Courtesy Elsevier

An operative procedure carried out under anaesthesia whereby the fetus, placenta and membranes are delivered through an incision in the abdominal wall and the uterus.

Emergency caesarean section (C-section) is carried out when adverse conditions develop during pregnancy or labour. Examples of indications for emergency C-section include:

  • Antepartum haemorrhage
  • Cord prolapse
  • Uterine rupture
  • Cephalopelvic disproportion diagnosed in labour
  • Fulminating pre-eclampsia, eclampsia
  • Fetal compromise if birth is not imminent

Elective C-section is so-termed when the decision to carry out the procedure has been taken during pregnancy, before labour has commenced. Indications include:

Definite

  • Cephalopelvic disproportion
  • Major degree of placenta praevia
  • High order multiple pregnancy

Possible

  • Breech presentation
  • Moderate to severe pre-eclampsia
  • Medical condition that warrants the exclusion of maternal effort
  • Diabetes mellitus
  • Intrauterine growth restriction
  • Certain fetal abnormalities (e.g. hydrocephalus)

Regional anaesthesia remains the safer option but general anaesthesia is sometimes required.

  • Regional anaesthesia is incompatible with any maternal coagulation disorder
  • General anaesthesia can be administered more rapidly
  • Maternal preference should be considered

Complications include infection and thromboembolic disorders See also Vaginal birth after Caesarean section (VBAC)

Further reading

National Institute of Health and Care Excellence (2011). Caesarean section CG132. https://www.nice.org.uk/guidance/cg132

 

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