Malpresentations and Positions & Operative Obstetrics
All the following are indications of caesarean section EXCEPT (AIIMS Nov 2011)
|A||Type IV placenta praevia|
|C||Untreated carcinoma cervix stage IB|
|D||Active herpes genital|
Indication of caesarean section
1. Pelvic contraction and dystocia due to
a. Fetopelvic disproportion, fetal malpresentations and malposition, in coordinate uterine action
b. Non progress of labour, soft tissue dystocia, constriction ring, vaginal stenosis, cervical rigidity
c. Neoplasm - fibroids impacted ovarian cysts or non pregnant horn of bicornuate uterus obstructing labour
d. Congenital anomalies of bony pelvis - Naegele's pelvis, Robert's pelvis or acquired abnormalities from fracture or bony neoplasms. Failed forceps and threatened uterine rupture.
2. Previous uterine surgery - C.S., Myomectomy, hysterotomy, utriculo- or metroplasty, cornual implantation of fallopian tubes
3. Hemorrhage -placenta praevia, Abruptio-placentae, vaso praevia, cancer cervix
4. Maternal medical disorders -severe hypertension, preeclampsia and eclampsia, Renal disease, DM, coarctation of the aorta, herpes gestationalis, Malignant disease e.g. leukaemia, prior to chemotherapy.
5. Maternal obstetric and health problems
a. Elderly primigravida, prolonged previous infertility, previous plastic repair of the vagina-genital prolapse, stress incontinence, Bad obstetric history, Previous difficult vaginal delivery, Abdominal cerclage for incompetent os, umbilical cord prolapse, persistent brow and mentoposterior positions, placental insufficiency [IUGR], Macrosomia.
b. Breech presentation, transverse lies, compound presentation
c. Multiple pregnancies - Triplets and over.
d. In abruption, LSCS is done if there is
i. Appearance of fetal distress
ii. Associated complicating factors
e. Vaginal delivery is preferred especially when the mother is in good condition and rapid delivery is anticipated if the cervix is dilated and the presenting part lying well within the pelvis, caesarean section otherwise should be avoided as far as possible unless obstetric indication arise