Table 1 Definition of unnecessary caesarean delivery
Foetal distress | Labour dystocia | Previous caesarean section | Pre-eclampsia/eclampsia |
|---|---|---|---|
• Caesarean for foetal distress with clear amniotic fluid, normal1 temperature, normal progression of cervical dilation and foetal descent, and normal foetal heart rate (120–160 beats/min) • Caesarean for foetal distress with abnormal foetal heart rate (< 120 or > 160 beats/min or repeated deceleration) or coloured amniotic fluid without implementation of intrauterine resuscitative measures (oxygen administration and the mother in the left lateral decubitus position) • Caesarean for foetal distress at full cervical dilation with engaged head and without attempted instrumental delivery (forceps or vacuum) | • Caesarean for suspected foetal macrosomia without ultrasonography or clinical evidence of macrosomia • Caesarean for slow dilatation with intact membranes • Caesarean for slow dilation with ruptured membranes, adequate2 uterine contractions and arrest < 4 h • Caesarean for slow dilation with ruptured membranes, inadequate uterine contractions, and no augmentation with oxytocin • Caesarean for slow dilation with ruptured membranes, augmentation with oxytocin, and arrest < 6 h • Caesarean at full cervical dilation for non-engagement of presentation with women allowed to push for less than 2 h • Caesarean at full cervical dilation with engaged head and without attempted instrumental delivery (forceps or vacuum) | • Caesarean without contraindication for a trial of labour after a single caesarean section with a transversal scar, a singleton foetus in cephalic presentation, no ultrasonography or no clinical evidence of macrosomia, no pelvimetry or no clinical evidence of a restricted pelvis • Caesarean during labour without protraction or arrest disorders, lack of evidence of foetal distress, no documented signs of uterine rupture • Caesarean at full dilation with engaged head and without attempted instrumental delivery (forceps or vacuum) | • Caesarean for pre-eclampsia with lack of evidence of foetal distress3 or foetal growth restriction4, lack of signs of severity for the woman5 and normal progression of cervical dilation (> 2 cm in 4 h) • Caesarean for pre-eclampsia or eclampsia with normal progression at full dilation (no arrest > 3 h) |