Caesarean Section (CS)

🤰 About

• Pregnant women should be offered evidence-based information and support to make informed decisions about childbirth.
• Their views and concerns are integral to the decision-making process.
• Consent for caesarean section (CS) must be obtained respectfully, with dignity, privacy, and cultural sensitivity, while considering the clinical situation.
• The category and reason for CS must be clearly documented in maternity records by the decision-maker for safe communication between professionals.

📖 Definition

• Lower Segment Caesarean Section (LSCS): A surgical operation to deliver baby/babies through a cut in the abdomen and lower segment of the uterus (RCOG 2010).

🗓️ Elective LSCS

• Risk of neonatal respiratory morbidity is higher if CS is performed before 39+0 weeks; therefore avoid elective CS before this gestation (NICE 2011).
• A consultant obstetrician should always be involved unless immediate delivery is required for safety.
• Rapid delivery may be harmful in some situations — careful assessment is needed.
• A senior clinician must review all women pre-surgery, and the plan (including indication) should be clearly documented in the maternity EPR.
• Postoperative care plans must include appropriate observation and discussion of future pregnancy implications, documented before discharge.

🚨 GRADE 1: CRASH

• Definition: Immediate threat to mother or fetus. ➝ Aim for delivery <30 minutes.
• Immediate transfer to theatre; call consultant obstetrician & anaesthetist if required.
• Indications:
  • Fetal bradycardia >4 minutes
  • Abnormal CTG (no FBS available)
  • FBS: lactate >4.8 or pH ≤7.20
  • Massive abruption, uterine rupture, cord prolapse
  • Failed instrumental delivery
  • Maternal cardiac arrest (within 4 min to aid resuscitation)
  • Advanced breech with rapid labour

⏱️ GRADE 2: URGENT

• Definition: Maternal or fetal compromise but not immediately life-threatening. ➝ Aim <75 minutes.
• Liaise with anaesthetist and transfer to theatre as soon as safe. Document delays.
• Coordinator to notify theatre, obstetric, anaesthetic, and paediatric teams.
• Indications:
  • Non-reassuring CTG (not abnormal)
  • Moderate abruption/APH
  • Failure to progress
  • Undiagnosed breech in labour
  • Maternal exhaustion or request during labour

📌 GRADE 3: SCHEDULED

• Definition: Early delivery needed but no immediate compromise. ➝ Aim <24 hours.
• Consultant obstetrician specifies timing; coordinator informs full team.
• Indications:
  • Planned LSCS in early labour/with pre-labour SROM
  • Failed induction of labour
  • Preeclampsia requiring CS after stabilisation
  • IUGR needing delivery
  • Delayed elective CS due to emergencies

📅 GRADE 4: PLANNED

• Definition: Planned on elective list, usually 39+0 to 39+6 weeks (consultant must approve earlier).
• Give antenatal steroids if <39 weeks.
• Can occasionally be booked at 41–42 weeks where induction is avoided.
• Indications:
  • Placenta praevia (~38 weeks)
  • Failed ECV
  • Breech/malpresentation
  • Multiple pregnancy (timing depends on chorionicity)
  • Previous ≥2 LSCS or classical LSCS
  • Previous major uterine surgery (e.g. myomectomy)
  • Maternal request
  • Medical/structural contraindications to vaginal delivery

👩‍⚕️ Duties: Consultant Obstetrician (Grades 1–3)

• Must be directly involved in decision, urgency classification, and communication with team.
• Support and supervise junior colleagues during high-risk cases.

👩‍⚕️ Duties: Specialty Obstetrician (Grades 1–3)

• Inform consultant on call, document grade & reason in maternity EPR, notify coordinator immediately.
• Explain risks/complications to woman and obtain written consent.
• Prescribe 40 mg IV omeprazole for emergency CS (unless oral given within 6 hrs).
• Ensure anaesthetic, paediatric, and theatre teams aware of urgency and comorbidities.
• Take cord blood samples and hand promptly to coordinator.
• Review woman within 24 hrs post-surgery; discuss delivery, future pregnancy implications, and document in maternity EPR.

📚 References

• NHS Guideline Document