Indications for C-section in a woman with pre-eclampsia

1. Non-reassuring fetal status
   • Persistent fetal bradycardia
   • Pathological CTG / fetal distress
   • Severe fetal compromise requiring immediate birth
2. Maternal condition requires urgent delivery and vaginal birth would take too long
   • Uncontrolled severe hypertension despite treatment
   • Eclampsia not stabilizing or recurrent seizures after initial stabilization
   • Pulmonary edema, worsening renal failure/oliguria, HELLP syndrome with deterioration, DIC, or suspected placental abruption
   • Persistent severe neurological symptoms or severe epigastric/right-upper-quadrant pain with worsening condition
3. Failed induction of labour or failure to progress
   • Especially if delivery is indicated but induction does not establish effective labour or there is arrest of labour.
4. Usual obstetric indications
   • Placenta previa or vasa previa
   • Transverse lie or other presentation unsuitable for vaginal birth
   • Cord prolapse
   • Cephalopelvic disproportion / obstructed labour
   • Previous classical C-section or another contraindication to labour
   • Certain cases of breech presentation, depending on gestation, fetal status, and local expertise.
5. Very preterm pregnancy with an unfavourable cervix plus an urgent need for delivery
   • This is an individualized decision. A very low chance of timely successful induction, combined with maternal or fetal deterioration, may favor C-section.

Important exam point

• Eclampsia alone is not an indication for C-section. Stabilize the mother first, control seizures and blood pressure, then choose the mode of delivery based on fetal condition, gestational age, presentation, cervical status, and urgency.
• In pre-eclampsia without severe features, vaginal delivery is generally preferred. Even in severe pre-eclampsia, delivery should not automatically mean C-section. The maternal-fetal medicine text states that expediting delivery in severe pre-eclampsia does not mandate immediate cesarean birth; cervical ripening and induction can be considered. Creasy & Resnik’s Maternal-Fetal Medicine, section “Preeclampsia With Severe Features.”