What are the indications for cesarean delivery (C-section) that benefit both the mother and fetus?

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

Answer

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

  • Abnormal placentation

  • Abnormal labor due to cephalopelvic disproportion

  • Situations in which labor is contraindicated

In the presence of a placenta previa (ie, the placenta covering the internal cervical os), attempting vaginal delivery places both the mother and the fetus at risk for hemorrhagic complications. This complication has actually increased as a result of the increased incidence of repeat cesarean deliveries, which is a risk factor for placenta previa and placenta accreta. Both placenta previa and placenta accreta carry increased morbidity related to hemorrhage and need for hysterectomy. [58, 59, 38]

Cephalopelvic disproportion can be suspected on the basis of possible macrosomia or an arrest of labor despite augmentation. Many cases diagnosed as cephalopelvic disproportion are the result of a primary or secondary arrest of dilatation or arrest of descent. Predicting true primary or secondary arrest of descent due to cephalopelvic disproportion is best assessed by sagittal suture overlap, but not lambdoid suture overlap, particularly where progress is poor in a trial of labor. [60]

Continuing to attempt a vaginal delivery in this setting increases the risk of infectious complications to both mother and fetus from prolonged rupture of membranes. [61] Less often, maternal hemorrhagic and fetal metabolic consequences occur from a uterine rupture, especially among patients with a previous cesarean delivery. [18] Vaginal delivery can also increase the risk of maternal trauma and fetal trauma (eg, Erb-Duchenne or Klumpke palsy and metabolic acidosis) from a shoulder dystocia. [62, 63]

Among women who have a uterine scar (prior transmural myomectomy or cesarean delivery by high vertical incision), a cesarean delivery should be performed prior to the onset of labor to prevent the risk of uterine rupture, which is approximately 4-10%. [18]


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