Cesarean Delivery Indications: Obstetric and Maternal Factors

Obstetric Indications

• Fetal distress (non‑reassuring heart tracing)
• Malpresentation (breech, transverse, face)
• Multiple gestation (especially higher‑order, or twin A non‑vertex)
• Prior classical uterine incision or myomectomy entering cavity
• Placenta previa, vasa previa
• Abruptio placentae
• Preeclampsia with severe features or failed induction
• Active genital herpes at labor
• Congenital anomalies preventing vaginal delivery

Maternal Indications

• Severe cardiac/pulmonary disease
• Uncontrolled HIV with high viral load
• Prior extensive uterine surgery
• Maternal request (after counseling on risks/benefits)

Decision‑making balances maternal/fetal risks; shared decision‑making and documentation are essential.