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Cesarean Delivery

Date: May 19,2015   Read: 
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Cesarean delivery is defined as the delivery of a fetus through surgical incisions made through the abdominal wall (laparotomy) and the uterine wall (hysterotomy).

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.

Maternal indications for cesarean delivery include the following:

1. Repeat cesarean delivery

2. 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

3. Pelvic abnormalities that preclude engagement or interfere with descent of the fetal presentation in labor

Fetal indications for cesarean delivery include the following:

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

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

3. Certain congenital malformations or skeletal disorders

4. Infection

5. 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

Evaluation by the surgeon and the anesthesiologist

Laboratory testing

The following laboratory studies may be obtained prior to cesarean delivery:

Complete blood count

Blood type and screen, cross-match

Screening tests for human immunodeficiency virus, hepatitis B, syphilis

Coagulation studies (eg, prothrombin and activated partial thromboplastin times, fibrinogen level)

Imaging studies

In labor and delivery, document fetal position and estimated fetal weight. Although ultrasonography is commonly used to estimate fetal weight, a prospective study reported the sensitivity of clinical and ultrasonographic prediction of macrosomia, respectively, as 68% and 58%.


Approximately 2-fold increase in maternal mortality and morbidity with cesarean delivery relative to a vaginal delivery : Partly related to the procedure itself, and partly related to conditions that may have led to needing to perform a cesarean delivery

Infection (eg, postpartum endomyometritis, fascial dehiscence, wound, urinary tract)

Thromboembolic disease (eg, deep venous thrombosis, septic pelvic thrombophlebitis)

Anesthetic complications

Surgical injury (eg, uterine lacerations; bladder, bowel, ureteral injuries)

Uterine atony

Delayed return of bowel function

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