better to know this just litle knowledge on caesarian section indications

1. DR.DARMIAN BON MASESE
MVUMI INSTITUTE OF HEALTH
COMMON INDICATIONS FOR
CAESARIAN SECTION
• Definition
• indications

2. • Indications of caesarian section refers to the factors which drives
towards decisions for operative delivery which when such an
intervention is not taken the patient may end up to big complication
• The c/s indication may be absolute or relative indications
• Absolute indications are those which can not be modified with other
management out of operative delivery
• Relative indication are the modifiable factors

3. Absolute indication Relative indication
1. Central placenta praevia
2. Contracted pelvis or Cephalopelvic disproportion
(CPD)
3. Obstructing pelvic mass eg cervical or broad
ligament fibroid
4. Advanced cervical carcinoma
5. Transverse fetal lie ( (fetal malpresentation)
6. Fetal malpresentation eg face presentation, cord
presentation or cord prolapse
7. Vaginal obstruction eg atresia, stenosis
1. CPD (Big baby)
2. Previous c/s with recurrent indication
3. Non reassuring FHR status
4. Dystocia
5. Antepartum hemorrhages
6. Malpresentation
7. Failure of induction
8. Bad obstetrics history
9. Hypertensive disorders eg severe pre eclampsia,
eclampsia
10. Medical gynecological disorders eg DM, heart
diseases

4. Indications for caesarian section is further sub classified as follows
• Birth canal abnormality
Cephalo pelvic disproportion
Pelvic tumors
Previous scars, caesarean section, perinearaphy, Vesico-Vaginal Fistula (VVF) and Rectal
Vaginal Fistula (RVF) repair
Cervical/vaginal stenosis
• Foetal malpresentation and lie
Breech
Brow
Face - mental posterior
Cord presentation/prolapse
Transverse lie
• Abnormalities of labor
Obstructed labor
Antepartum Hemorrhage (APH)
Foetal distress
Eclampsia
Placenta praevia

5. TRIAL OF SCAR ( VAGINAL DELIVERY AFTER C/S)
• Providing a pregnant woman with an opportunity to deliver vaginally,
when she has a previous caesarean scar/history of C/S
• The women is provided with an opportunity when the cause of the
previous c/s is not recurrent
• Close monitoring of labor should be done using partograph
• If a mother has had one Caesarean section the alternatives for her
next pregnancy are:
• An elective section, at 38weeks;Section in early labour or An attempt
at vaginal delivery (a ‘trial of scar’). How can you choose between
these three

6. INDICATIONS FOR TRIAL LABOR AFTER CAESARIAN SECTION
• Indication for the previous caesarean section should be non-recurrent
A patient who has had one lower segment Caesarean section, and the reason for it is absent in
this pregnancy. For example, it might have been done for a malposition or malpresentation,
maternal or foetal distress, or CPD due to hydrocephalus, etc
• Healing of the uterine scar was without sepsis
• The previous caesarean should be more than two years prior to this delivery
• Must be single previous scar
She must have had not more than one previous Caesarean section, Caesarean section must be
available any time of the day or night, within one hour of the decision to section her
• The fetus must be in cephalic presentation
Her baby must be a vertex presentation in the occipito–anterior position
• Singleton pregnancy
It should not be a multiple pregnancy
• The maternal pelvis should be adequate
• There must be no foetal or maternal distress
• The scar from a myomectomy (provided her uterine cavity was not opened during the operation),
hysterotomy, or uterine perforation during a ‘D and C’
• The previous c/s scar should not be that of classical incision
• Facilities for emergency caesarean must available

7. CONTRA INDICATIONS OF TRIAL OF LABOR
• Two or more previous lower segment c/s should not be tried
• One classical incision previous c/s scar
• Any degree of CPD or suspected CPD
• An occipito posterior position
• Any form malpresentation or obstetrics complication
• Sepsis following C/ S (relative contra indication)
• Any need for oxytocin drip

8. END
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