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Table 1 Definition of unnecessary caesarean delivery

From: DECIDE: a cluster-randomized controlled trial to reduce unnecessary caesarean deliveries in Burkina Faso

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)
  1. 1Temperature of 37.5 °C
  2. 2Three contractions in 10 min, each contraction lasting more than 40 s
  3. 3Fetal heart rate (between 120 and 160 beats/min) without slowing
  4. 4Weight below the 10th percentile for gestational age
  5. 5Signs of severe pre-eclampsia: blood pressure ≥ 160/110 mmHg; albuminuria, with urinary albumin ≥ 3+ or ≥ 3 g/24 h; oliguria, with urinary flow < 30 mL/h; headache; epigastric pain; vision disorders; neurological disorders; seizures; haemolysis; low platelet count and high levels of liver enzymes