Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
Caesarean birth indications and consent
Obstetrics and gynaecology · UK scope · Sources checked 7 Sept 2026 · Clinical review pending
!Recognise an immediate threatSuspected uterine rupture, persistent fetal bradycardia, major abruption or cord prolapse can require category 1 caesarean birth. Resuscitation, theatre preparation and communication proceed together.
Action: Call senior obstetric, anaesthetic, theatre and neonatal staff, treat reversible causes immediately and arrange birth as soon as possible according to the maternal and fetal condition.
Synopsis
Choose and explain caesarean birth using the clinical indication, urgency, individual preferences and a practical plan for safe surgery and recovery.
- Record the indication and urgency separately because the same underlying condition can present with different degrees of compromise.
- Category 1 involves an immediate threat to life; category 2 involves compromise that is not immediately life-threatening.
- Arrange category 1 birth as soon as possible, usually within 30 minutes; category 2 usually within 75 minutes.
- Plan uncomplicated scheduled caesarean birth at or after 39 weeks to reduce neonatal respiratory morbidity.
- Explore a maternal request sensitively, provide balanced information and support the informed choice after discussion.
- Give surgical antibiotic prophylaxis before incision and assess thromboprophylaxis, anaesthesia, haemorrhage risk and postoperative analgesia.
Key red flags
Persistent profound fetal bradycardia despite initial corrective measures requires immediate reassessment of the fastest safe route of birth.
Maternal collapse, heavy bleeding or suspected uterine rupture needs simultaneous resuscitation and emergency operative planning.
A previous uterine scar with a low anterior placenta raises concern for placenta accreta spectrum and requires specialist planning.
New breathlessness, chest pain or unilateral leg swelling after caesarean birth warrants urgent assessment for venous thromboembolism.
Investigation priorities
01Full blood countFirst stepIdentify anaemia and assess the platelet count before operative birth.
Management branches
Planned birthPrepare an individual scheduled operationCaesarean birth is agreed antenatally without a need for earlier urgent delivery.
- Review the indication, discuss reasonable alternatives and record the person's priorities, material risks and agreement to the operation.
- Schedule birth from 39 weeks unless a specific maternal or fetal indication supports earlier delivery, and record what to do if labour starts beforehand.
- Arrange blood tests, anaesthetic assessment, antibiotic and thromboprophylaxis plans; involve specialist teams when bleeding or medical risk is increased.
- Confirm the clinical picture on admission and accommodate preferences for a companion, contact with the baby and communication during surgery where feasible.
Key medicines
Carbetocin for uterine atony prophylaxisFor caesarean under spinal or epidural anaesthesia, PABAL is given as 100 micrograms intravenously over one minute once, after the baby is born and preferably before placental delivery.Do not repeat carbetocin or administer it before birth. PABAL contraindicates hepatic or renal disease, serious cardiovascular disorders and epilepsy. Persistent bleeding requires investigation and further appropriate therapy, not another carbetocin dose.
Pre-incision antibiotic prophylaxisAdminister the maternity surgical prophylaxis regimen intravenously before skin incision, choosing the specified agent and dose for allergy status, weight and renal function.NICE advises against co-amoxiclav for pre-incision caesarean prophylaxis. Select the local regimen explicitly; treatment for infection and prophylaxis after assisted vaginal birth are different prescribing situations.
Sources and review status4 sources · checked 7 Sept 2026 · clinical review pending+
SourcesSources and review status
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.
Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes
Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom