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Table 3 Examples of scenarios under each indication that the panel members agreed on the appropriateness (inappropriateness) of cesarean section.*

From: Developing criteria for Cesarean Section using the RAND appropriateness method

Repeat cesarean with  
Three or more previous cesarean (A)
Classic scar (A)
Unknown scar (A)
Previous rupture of uterine (A)
Preterm delivery with  
Down syndrome (I)
Anencephaly (I)
Eclampsy <30 weeks of pregnancy (A)
History of fever in previous cesarean due to infections (A)
Fetal distress  
Sever Decolman (A)
Bradycardia (A)
Tachycardia (A)
Decrease of variability (A)
Chronic distress  
IUGR^, BPS# normal, pregnancy <30 weeks and Bishop score <5 (A)
IUGR, BPS normal, pregnancy <30 weeks and Bishop score >5 (A)
ADF$, IUGR, BPS normal, pregnancy 34-37 weeks (A)
ADF, IUGR, BPS normal, pregnancy 30-34 weeks (A)
Macrosomia and  
Diabetic mother, fetal weight > 4000 g (A)
Parity > 5 (A)
Previous traumatic delivery (A)
Post term > 41 weeks, Bishop appropriate (I)
Multiple pregnancy  
Twin, mono amnion with sonography (A)
Twin, di-amnion, both non cephalic, normal weight and age (A)
Twin, cephalic-non cephalic, both with normal weight (A)
Twin, non cephalic-cephalic, both with normal weight (A)
Breech and  
Decolman (A)
Placenta previa (A)
Nuliparous mother (A)
Unknown footling (A)
Dystocia of soft tissues  
Arrest of dilatation: delayed long phase (more than 3 hours in nullipara and more than 1 hour in multipara) with appropriate contraction, no CPD (A)
Arrest of dilatation (more than 2 hours in nullipara & multipara) with appropriate contraction, no CPD (I)
Failure to progress: nulliparous, insufficient dilatation of cervix ( < 1.2 cm/hr), appropriate contraction, no CPD (I)
Failure to progress: multiparous, insufficient dilatation of cervix ( < 1.5 cm/hr), appropriate contraction, no CPD (A)
Pelvic dysfunctions and abnormal presentation of fetus
Inlet: posterior-anterior diameter <10 cm (A)
Inlet: transversal diameter <12 cm (A)
Inlet and mid pelvic contraction (A)
Fetal anomaly  
Hydrocephalus fetus (A)
Macrocephalus fetus (A)
NTD Open (A)
Hydrops fetalis (A)
Mother characteristics  
> 12 kg weight increase in pregnancy (I)
> 18 kg weight increase in pregnancy (I)
Sever coronary artery disease (A)
Mother with asthma (A)
Uterine anomaly  
Previous surgery on uterine including opening the endometrial tissue (A)
Pelvic contraction caused by rickets or trauma (A)
Over distention of the uterine and need to end the pregnancy (A)
Hemorrhage and premature rupture of membrane
Rupture of membrane for <18 hours (I)
Rupture of membrane for >18 hours and lack of labor (I)
Rupture of membrane >5 hours in patients with HIV (A)
Previa, fetus ≤34 week, light vaginal hemorrhage (I)
  1. *A: appropriate; I: inappropriate
  2. ^Intrauterine Growth Retardation, $Brain Parenchyma Sonography, #Advanced Dynamic Flow