Introduction
A caesarean section is the delivery of a baby through a surgical incision in the abdominal
and uterine wall(s).
Over the past couple of decades, the rates of caesarean sections have increased significantly
in western countries. In the United Kingdom, 25-30% of births were delivered by caesarean
section in 2015. In women who have had at least one previous caesarean section, the rate of
deliveries by this method increases to 67%.1
Figure 1. A caesarean section being performed.2
In this article, we will discuss the classification and indications for caesarean sections, plus
provide an overview of the procedure and associated complications.
You might also be interested in our surgical flashcard collection which contains over 500
flashcards that cover key surgical topics.
Classification
Caesarean sections can be classified into elective or emergency:1
● Category 1 – immediate (“crash”): these are performed when there is an immediate
threat to the life of the woman or fetus. Delivery should take place as soon as possible.
The Royal College of Obstetricians and Gynaecologists recommends that a category 1
section should be performed within 30 minutes of making the decision for caesarean
delivery.
● Category 2 – urgent: these are indicated when there is maternal or fetal compromise,
which is not immediately life-threatening. To be performed as soon as possible, and
within 75 minutes of decision for delivery.
● Category 3 – scheduled: this category of C-section is indicated where there is no
maternal or fetal compromise, but early delivery is required.
● Category 4 – elective: the timing of this delivery is planned to suit the woman and staff.
, Indications
Indications for a category 1 (crash) caesarean section include:
● Cord prolapse
● Sustained fetal bradycardia
● Fetal hypoxia (scalp pH < 7.20)
● Placental abruption
● Uterine rupture
Indications for a category 2 (urgent) caesarean section include:
● Failure to progress in labour with pathological CTG
Indications for a category 3 (scheduled) caesarean section include:
● Intrauterine growth restriction with poor fetal function tests
● Failed induction of labour
● Breech in labour
Indications for a category 4 (elective) caesarean section include:
● Previous caesarean section
● Breech presentation
● Other malpresentations
● Twin pregnancy where the first twin is not a cephalic presentation
● Placenta praevia
● Maternal HIV
● Primary genital herpes in the third trimester
● Previous hysterotomy or “classical” caesarean section
● Maternal diabetes with an estimated fetal weight >4.5kg in cases where vaginal delivery
is unlikely to be successful
● Maternal request
Elective caesarean sections are normally planned around 39 weeks gestation. This is to
reduce the risk of the neonate developing respiratory distress in neonates born at earlier
gestations, known as transient tachypnoea of the newborn.
Procedure
Peri-operative and anaesthetic concerns
Before a caesarean section, there are several steps and investigations that should be
performed to reduce morbidity associated with the procedure:
A caesarean section is the delivery of a baby through a surgical incision in the abdominal
and uterine wall(s).
Over the past couple of decades, the rates of caesarean sections have increased significantly
in western countries. In the United Kingdom, 25-30% of births were delivered by caesarean
section in 2015. In women who have had at least one previous caesarean section, the rate of
deliveries by this method increases to 67%.1
Figure 1. A caesarean section being performed.2
In this article, we will discuss the classification and indications for caesarean sections, plus
provide an overview of the procedure and associated complications.
You might also be interested in our surgical flashcard collection which contains over 500
flashcards that cover key surgical topics.
Classification
Caesarean sections can be classified into elective or emergency:1
● Category 1 – immediate (“crash”): these are performed when there is an immediate
threat to the life of the woman or fetus. Delivery should take place as soon as possible.
The Royal College of Obstetricians and Gynaecologists recommends that a category 1
section should be performed within 30 minutes of making the decision for caesarean
delivery.
● Category 2 – urgent: these are indicated when there is maternal or fetal compromise,
which is not immediately life-threatening. To be performed as soon as possible, and
within 75 minutes of decision for delivery.
● Category 3 – scheduled: this category of C-section is indicated where there is no
maternal or fetal compromise, but early delivery is required.
● Category 4 – elective: the timing of this delivery is planned to suit the woman and staff.
, Indications
Indications for a category 1 (crash) caesarean section include:
● Cord prolapse
● Sustained fetal bradycardia
● Fetal hypoxia (scalp pH < 7.20)
● Placental abruption
● Uterine rupture
Indications for a category 2 (urgent) caesarean section include:
● Failure to progress in labour with pathological CTG
Indications for a category 3 (scheduled) caesarean section include:
● Intrauterine growth restriction with poor fetal function tests
● Failed induction of labour
● Breech in labour
Indications for a category 4 (elective) caesarean section include:
● Previous caesarean section
● Breech presentation
● Other malpresentations
● Twin pregnancy where the first twin is not a cephalic presentation
● Placenta praevia
● Maternal HIV
● Primary genital herpes in the third trimester
● Previous hysterotomy or “classical” caesarean section
● Maternal diabetes with an estimated fetal weight >4.5kg in cases where vaginal delivery
is unlikely to be successful
● Maternal request
Elective caesarean sections are normally planned around 39 weeks gestation. This is to
reduce the risk of the neonate developing respiratory distress in neonates born at earlier
gestations, known as transient tachypnoea of the newborn.
Procedure
Peri-operative and anaesthetic concerns
Before a caesarean section, there are several steps and investigations that should be
performed to reduce morbidity associated with the procedure:
