## Most Common Maternal Indication for Cesarean Delivery **Key Point:** Previous cesarean section (repeat cesarean delivery) is the most common single indication for cesarean delivery globally and in India, accounting for 30–40% of all cesarean sections. This reflects the high repeat cesarean rate and the relative contraindication to vaginal birth after cesarean (VBAC) in many settings. ### Epidemiology of Repeat Cesarean Delivery **High-Yield:** In most developed and developing countries, including India: - **30–40%** of all cesarean sections are repeat procedures - **60–70%** of women with a prior cesarean deliver by repeat cesarean - Only **20–40%** of eligible women attempt VBAC - Success rate of VBAC is **60–80%** when attempted ### Why Repeat Cesarean is the Most Common Indication 1. **Cumulative effect** — Each cesarean delivery increases the likelihood of repeat cesarean in subsequent pregnancies 2. **Maternal choice** — Many women and providers prefer planned repeat cesarean over the risks of VBAC 3. **Uterine scar concerns** — Fear of uterine rupture (risk ~0.5–1%) influences decision-making 4. **Lack of VBAC facilities** — Many centers in India lack adequate monitoring and emergency capability for VBAC ### Comparison of Common Cesarean Indications | Indication | Frequency (%) | Category | Preventable? | |------------|---------------|----------|-------------| | Repeat cesarean | 30–40 | Maternal | Partially (VBAC trial) | | Failure to progress | 20–30 | Maternal | Partially (augmentation) | | Fetal distress | 10–15 | Fetal | Partially (monitoring) | | Placenta previa | 5–10 | Placental | No | | Preeclampsia | 3–5 | Maternal | No | **Clinical Pearl:** The high rate of repeat cesarean delivery has led to increasing maternal morbidity from multiple cesarean sections, including placental abnormalities (accreta, increta), adhesions, and increased operative time. This has prompted guidelines to encourage VBAC trials in appropriate candidates. ### Criteria for VBAC Trial **Mnemonic: "VBAC SAFE" — Candidates for vaginal birth after cesarean** - **V**aginal delivery possible (no absolute contraindication) - **B**ack-up cesarean available immediately - **A**ppropriate monitoring (continuous fetal heart rate) - **C**ontraction monitoring (assess for uterine rupture) - **S**ingle prior low-transverse incision - **A**bsence of contraindications (placenta previa, vasa previa, prior classical cesarean) - **F**acility with anesthesia and surgical team on-site - **E**ligible maternal age and BMI **Warning:** Do not confuse the most common indication for cesarean (repeat cesarean) with the most common indication for primary cesarean (failure to progress). In first-time mothers, FTP is most common; in the overall cesarean population, repeat cesarean is most common. [cite:Williams Obstetrics 26e Ch 22; ACOG Practice Bulletin 205]
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.