When is cesarean delivery (C-section) indicated?

Updated: Dec 14, 2018
  • Author: Hedwige Saint Louis, MD, MPH, FACOG; Chief Editor: Christine Isaacs, MD  more...
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Answer

Answer

Cesarean deliveries were initially performed to separate the mother and the fetus in an attempt to save the fetus of a moribund patient. They subsequently developed to resolve maternal or fetal complications not amenable to vaginal delivery, either for mechanical limitations or to temporize delivery for maternal or fetal benefit.

The leading indications for cesarean delivery (85%) are previous cesarean delivery, breech presentation, dystocia, and fetal distress. [7]

Maternal indications for cesarean delivery include the following:

  • Repeat cesarean delivery

  • Obstructive lesions in the lower genital tract, including malignancies, large vulvovaginal condylomas, obstructive vaginal septa, and leiomyomas of the lower uterine segment that interfere with engagement of the fetal head

  • Pelvic abnormalities that preclude engagement or interfere with descent of the fetal presentation in labor  ​
  • Certain cardiac conditions that preclude normal valsalva done by patients during a vaginal delivery [8]

Fetal indications for cesarean delivery include the following:

  • Situations in which neonatal morbidity and mortality could be decreased by the prevention of trauma

  • Malpresentations (eg, preterm breech presentations, non-frank breech term fetuses)

  • Certain congenital malformations or skeletal disorders

  • Infection

  • Prolonged acidemia

Indications for cesarean delivery that benefit the mother and the fetus include the following:

  • Abnormal placentation (eg, placenta previa, placenta accreta)

  • Abnormal labor due to cephalopelvic disproportion

  • Situations in which labor is contraindicated


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