Caesarean section

The rate of caesarean section has increased significantly in recent years, largely secondary to an increased fear of litigation

There are two main types of caesarean section:

• lower segment caesarean section: now comprises 99% of cases
• classic caesarean section: longitudinal incision in the upper segment of the uterus

Indications (apart from cephalopelvic disproportion/praevia, most are relative)

• absolute cephalopelvic disproportion
• placenta praevia grades 3/4
• pre-eclampsia
• post-maturity
• IUGR
• fetal distress in labour/prolapsed cord
• failure of labour to progress
• malpresentations: brow
• placental abruption: only if fetal distress; if dead deliver vaginally
• vaginal infection e.g. active herpes
• cervical cancer (disseminates cancer cells)

Caesarean sections may be categorised by the urgency