7/25/2019 The Most Frequent Reasons for Performing a Cesarean Childbirth

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The Most Frequent Reasons for Performing a Cesarean Childbirth

The most frequent reasons for performing a cesarean delivery are discussed below.

Repeat cesarean delivery:There are two types of uterine incisions - a low transverseincisionand a vertical uterine incision. The direction of the incision on the skin (up and

down or side to side) does not necessarily match the direction of the incision made in the

uterus.

o As the name implies, the low transverse incision is a horiontal cut across the

lower part of the uterus. !n the "nited #tates, whenever possible, a low skinincision below or at the bikini line with a low transverse uterine incision is the

approach of choice.

o A vertical incision on the uterus may be used for delivering pretermbabies,

abnormally positioned placentas, pregnancies with more than one fetus, and ine$treme emergencies.

o !n the last decade, studies have shown that women who have had a prior cesarean

section with a low transverse incision may safely and successfully go throughlabor and have a vaginal delivery in later pregnancies. The same, however, cannot

be said of women who have had vertical incisions on the uterus if the incision is

in the higher portion of the uterus.

!n women with high vertical uterine incisions, the uterus is at a greater risk

to rupture (break open) in a subsequent pregnancy.

The uterus may rupture even before labor begins in half of these women.

"terine rupture can be dangerous to the fetus even if delivery is

accomplished immediately after a uterine rupture. %iagnosing a uterinerupture can be difficult, and signs of a rupture can include increased

bleeding,increasedpain,or an abnormal fetal heart rate tracing.

Previous cesarean deliveries:&omen with a prior history of more than one low

transverse cesarean section are at slightly increased risk for uterine rupture. This riskincreases significantly when the woman has had three cesarean deliveries. !f an

abdominal delivery is planned and a trial of labor is not an option, the best time for

delivery is determined when the lungsof the fetus are mature.

Lac of labor progression:!f the woman is having adequate contractions but no change

in the cervi$(opening to the uterus) beyond ' centimeters dilation or the woman isunable to deliver the fetus despite complete dilation of the cervi$ and adequate pushing

for (generally for to ' hours or more), cesarean delivery may be performed.

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7/25/2019 The Most Frequent Reasons for Performing a Cesarean Childbirth

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!bnormal position of the fetus:!n a normal delivery, the baby presents head first. This

is the way it happens in most births. The smallest diameter of the human skull is

presented to the pelvis in the most advantageous way. This increases the success of avaginal delivery.

o There are various other presentations of the fetus, which make vaginal deliverydifficult, including the commonly known breech position (when the baby*s

buttocks are in the lower portion of the uterus). +ertain forms of breech delivery

have a very low increased risk to the fetus. reech deliveries may cause morecomplications, including death and neurologic disability.

o +areful counseling, analysis of the e$act type of breech position, an estimate of

the baby*s weight, and other information are required before making any decision

about an attempted vaginal delivery or delivery by cesarean section.

Fetal status:Although an attractive and much-used tool, the fetal heart rate monitor has

not improved birth outcomes as once e$pected. #ome believe the lack of improvedoutcomes is because many current practicing doctors are poorly trained in interpreting the

subtleties of fetal heart rate patterns. #ince the use of continuous fetal heart rate

monitoring in labor was begun, however, birth e$perts say death of a fetus during labor is

much more rare than in the past.

"mergency situations:!f the woman is severely ill or has a life-threatening inury or

illness with interruption of the normal heart or lung function, she may be a candidate for

an emergency cesarean section. &hen performed within -/0 minutes of the onset ofcardiac arrest,the procedure may save thenewbornand improve the resuscitation rate for

the mother. This procedure is performed only in the most dire of circumstances.

"lective sterili#ation:A desire for elective steriliation is not an indication for cesarean

delivery. #teriliation after a vaginal delivery can be performed via a tiny '-cm incision

along the lower edge of the umbilicus or as a delayed procedure weeks after deliverywith laparoscopic surgery or vaginal surgery.

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