An Overview of Caesarean Section
Caesarean section is a form of operative delivery wherein the baby is delivered abdominally. The caesarean takes its origin from an ancient roman law: "Lex Caesarea", a law which permitted cutting open of women’s body to retrieve the baby should the mother die just before childbirth. The myth that this procedure is named after Caesar is false as him mother lived long after he was born.
Caesarean Section: Some Statistics
- Internationally rates of caesarean section are increasing with the exception of Norway and Sweden.
- Northern European countries have the lowest rates of caesarean section and perinatal mortality.
- WHO recommends that the caesarean section rates should not exceed 15%, but in Wales and Northern Ireland the rates are around 25%.
- Fear of litigation is the major reason for increasing rates.
Reasons for increase in rates of Caesarean section
There are many reasons for the increasing rates of caesarean section. Both technological and social changes are responsible. The expectation is perhaps that every pregnancy should have a healthy outcome. More so because many women work full time and are choosing to delay and restrict the number of pregnancies they have.
Fear of litigation may be another major reason for the increase in rates in many developed countries.
Some women might have had a very bad experience during previous labour and thus may insist on caesarean during subsequent pregnancy.
Many studies have also found a correlation between rates of caesarean section and maternal age, with women over 34 having a higher chance of undergoing caesarean section.
The four major causes for caesarean section in the USA are
- Previous caesarean section (35%)
- Failure of normal labour to progress (30%)
- Breech presentation (10%)
- Foetal distress (8%)
Why is a caesarean section performed?
Caesarean section is of two types depending on whether it is planned or unplanned. Planned caesarean section is known is elective caesarean. Here both the surgeon and patient decide on the time of caesarean section around term, before normal onset of labour.
Indications for elective caesarean section are further sub divided in to definite and probable. A definite indication is one where there is no alternative except a caesarean section.
Definite indications
- A disproportionately large head as compared to maternal pelvis
- Major degree of placenta previa (a condition where the placenta encroaches upon lower segment of uterus.
- High order of multiple births (Quadruplets and above)
Possible indications
- Breech presentation
- Moderate to severe Pre-eclampsia
- A medical condition that warrants the exclusion of maternal effort during labour
- Intra uterine growth restriction
- Ante-partum haemorrhage
- Certain foetal abnormalities
Emergency caesarean section
This happens when the conditions of pregnancy dictate a caesarean section even when one is not planned.
The common reasons for emergency caesarean section are
- Ante-partum haemorrhage
- Cord prolapsed
- Uterine rupture
- Cepahlo-pelvic disproportion diagnosed during labour
- Fulminant pre-eclampsia
- Eclampsia
- Failure of labour to progress
- Foetal distress
Operative Procedure and Complication