Cesarean delivery

Guidelines

Key sources

The following summarized guidelines for the management of Cesarean delivery are prepared by our editorial team based on guidelines from the American College of Obstetricians and Gynecologists (ACOG 2025,2021,2020,2019,2018,2017), the Society of Obstetricians and Gynaecologists of Canada (SOGC 2022,2021,2020,2018,2017), the American Heart Association (AHA 2020), the Royal College of Obstetricians and Gynaecologists (RCOG 2019,2015,2012), the Enhanced Recovery After Surgery Society ...
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Perioperative care

Aspiration prophylaxis, acid suppression: as per ERASS 2018 guidelines, administer antacids and H2RAs as premedication to reduce the risk of aspiration pneumonitis.
B

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  • Antibiotic prophylaxis

  • Thromboprophylaxis

  • Fluid management

  • Hypothermia prevention

Surgical interventions

Indications for Cesarean delivery, macrosomia: as per RCOG 2012 guidelines, perform elective Cesarean delivery to reduce the potential morbidity for pregnancies complicated by preexisting or gestational diabetes, regardless of treatment, with an estimated fetal weight of > 4,500 g.
B

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  • Indications for Cesarean delivery (vasa previa)

  • Indications for Cesarean delivery (placenta previa)

  • Indications for Cesarean delivery (placenta accreta)

  • Indications for Cesarean delivery (resuscitative hysterotomy)

  • Indications for Cesarean delivery (maternal request)

  • Choice of anesthesia

  • Technical considerations for Cesarean delivery (field preparation)

  • Technical considerations for Cesarean delivery (incision)

  • Technical considerations for Cesarean delivery (closure)

Preventative measures

Primary prevention of Cesarean delivery, policies: as per ACOG 2025 guidelines, recognize the importance of safe and equitable reduction of nulliparous, term, singleton, vertex Cesarean birth as a primary consideration in all settings providing high-quality obstetric care. Achieve this through quality-improvement initiatives.
E
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  • Primary prevention of Cesarean delivery (first stage of labor)

  • Primary prevention of Cesarean delivery (second stage of labor)

  • Primary prevention of Cesarean delivery (fetal conditions)

  • Primary prevention of Cesarean delivery (maternal factors)

  • Primary prevention of Cesarean delivery (twin gestation)

  • Primary prevention of Cesarean delivery (induction of labor)

Follow-up and surveillance

Immediate care of the newborn at delivery, cord clamping: as per SOGC 2022 guidelines, delay cord clamping for 60-120 seconds in both preterm (< 37 weeks) and extremely preterm (< 28 weeks) singletons because it decreases newborn mortality and morbidity and improves hematological outcomes after the neonatal period. Delay cord clamping for at least 30 seconds over clamping immediately when cord clamping cannot be deferred for a full 60-120 seconds. Delay cord clamping with the infant at the level of the Cesarean incision.
A
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More topics in this section

  • Immediate care of the newborn at delivery (supportive care)

  • Immediate care of the newborn at delivery (vaginal seeding)

  • Vaginal birth after Cesarean delivery (indications for trial of labor)

  • Vaginal birth after Cesarean delivery (setting of care)

  • Vaginal birth after Cesarean delivery (antenatal counseling)

  • Vaginal birth after Cesarean delivery (technical considerations)

  • Management of Cesarean scar pregnancy