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Table 1 Criteria for non-medically indicated caesareans a

From: DECIDE: a cluster randomized controlled trial to reduce non-medically indicated caesareans in Burkina Faso

Previous caesarean section Prolonged/obstructed labour
Pre-labour caesarean not indicated if a:
- One previous caesarean section with transversal scar
- Singleton foetus in cephalic presentation
- Lack of ultrasound or clinical evidence of macrosomia
- Lack of radiographic or clinical evidence of restricted pelvis
- Possibility of performing emergency intra-partum caesarean section 24 h on call
Caesarean during labour not indicated if a:
- Same criteria as pre-labour caesarean (see above)
- Cervical dilation progressing normally (>2 cm in 4 h)
- Presentation progressing normally at full dilation (no arrest >3 h)
- Lack of evidence of foetal distressb
- No documented signs of uterine rupture
OR
Duration between full dilation and decision for caesarean delivery >3 h and no attempt of instrumental delivery (forceps or vacuum) if this is indicated
Pre-labour caesarean for presumed obstructed labour not indicated if a:
- Singleton foetus in cephalic presentation
- Lack of ultrasound or clinical evidence for macrosomia
- Lack of radiographic or clinical evidence of restricted pelvis
- No documented history of fistula or uterine malformation
- No documented history of uterine rupture
Caesarean for failed induction or slow dilation without foetal distress is not indicated if a:
- Membranes intact
OR
- Membranes ruptured, uterine contractions adequate and time elapsed since stagnation of dilation under 4 h
OR
- Membranes ruptured, uterine contractions inadequate, no attempt at augmentation with oxytocin
OR
- Membranes ruptured, uterine contractions inadequate, augmentation with oxytocin and time elapsed since stagnation of dilation under 6 h
Caesarean at full cervical dilation without foetal distress not indicated if a:
- Non-engagement of presentation and time elapsed between full dilation and decision for caesarean under 3 h
- Engaged head and instrumental delivery (forceps or vacuum) not attemped
Pre-eclampsia Foetal distress
Pre-labour caesarean not indicated if a:
- Lack of evidence of foetal distressb
- Lack of clinical or ultrasound evidence of foetal growth restriction
- No documented signs of severity for the womanc
- No documented signs of abruptio placentae
Caesarean during labour not indicated if a:
- Same criteria as pre-labour caesarean (see above)
- Cervical dilation progressing normally (>2 cm in 4 h)
- Presentation progressing normally at full dilation (no arrest >3 h)
Caesarean during labour not indicated if a:signs of abruptio placentae
- Clear amniotic fluid or not documented
-No maternal fever or not documented
- Cervix dilation or presentation progressing normally
- Foetal heart rate normal (120–160 beats/min.) OR abnormal but uncorrected (oxygen administration and mother on left side)
  1. aAll criteria are required
  2. bSigns of foetal distress: foetal heart rate abnormalities (<120 or >160 beats/min. or repeated decelerations); coloured amniotic fluid
  3. cSigns of severe pre-eclampsia: blood pressure ≥160/110 mmHg; albuminuria ≥3+ or ≥3 g/24 h; oliguria <30 mL/h; headache; epigastric pain; vision disorders; neurologic disorders; seizures; hemolysis; low platelet count; high liver enzymes