Why caesarean section is done for delivery of babies in some women by medical doctors

 By Dr Joel Enejeta

Caesarean section is one of the most commonly performed surgical procedures in obstetrics and it is certainly one of the oldest operations in surgery. The incidence is about 15 to 21% in most West Africa Countries.

Caesarean section can be defined as delivery of a foetus through a surgical incision into the uterine wall after 28 weeks of gestation.  It therefore means that non-surgical expulsion of the foetus/embryo from the uterine cavity or tubes following uterine rupture or ectopic pregnancy are not included.

Indications for Caesarean Section.       

Caesarean section is not a routine procedure, it is done for women who cannot achieve vaginal delivery due to some problems that may arise from the baby, mother or both.

In order to avoid complications that may arise during labour in high risk pregnant women, caesarean section is then carried out.

indications due to foetus(baby)  

1. Foetal distress especially in the first stage of labour.
2. Abnormal presentations/lie that persist after attempt at external cephalic versions such as transverse and oblique lie.
3. Face presentation (mento-posterior) when baby face is the foremost in the birth canal.
4. Multiple gestations. Triplets or greater gestation or when the lie of the leading twin is abnormal.
5. Macrosomia (Foetus weighing greater than 4.0 or 4.5kg)
6. Footling breech(when baby presents with foot instead of head)
7. Very low birth weight (<1500gm)
8. Foetal abnormality: Hydrocephallus, conjoined twins and spina bifida.
9. Vasa praevia.

Maternal indications. (indications due to mother)

1. Severe pre-eclampsia with unfavourable cervix for vaginal delivery.
2. Previous classical Casarean section.
3. Previous extensive uterine surgery such as myomectomy in which the endometrial cavity was breached.
4. Obstructive pelvic tumours (fibroids)
5. Previous third degree perineal tear and repair.
6. Previous reconstructive vaginal surgery.
7. Large vulva condylomata.
8. Vulva Herpes simplex virus.#

Maternal-foetal.(indications due to both mother and baby

1. Cephalopelvic disproportion (relative)
2. Failure to progress ( Arrest of cervical dilatation in the first stage of labour or arrest of descent in the second stage).
3. Major placenta praevia
4. Abruptio placenta with a live foetus.
5. Absolute pelvic disproportion.