Table 4.

Selected Potentially Modifiable Maternal Indications for First Cesarean Delivery

	Diagnostic Criteria Accuracy*	Effect on Prevention of First Cesarean Delivery†	Strategies to Prevent First Cesarean Delivery
Obesity (BMI higher than 40)	High	Small	Weight loss preconception, and limited weigh gain in pregnancy Education: obesity is not an indication for cesarean delivery, and is a poor predictor of cesarean delivery
Infection (HSV, HCV, HIV)	High	Small	HIV-treatment to minimize viral load
Cardiovascular disease (acute HTN crisis, cardiomyopathy, pulmonary HTN, cerebral aneurysm, CVA)	High	Small	Education: not an indication for cesarean delivery
Inadequate pelvis	Limited	Small	Education: not an indication for cesarean delivery
Request (no maternal, obstetrical or fetal indication)	Not applicable	Small	Education of patient and provider regarding acute complications and long term risks, benefits and impact of cesarean on mom and baby. Specific education on fear of labor, etc

BMI, body mass index; HSV, herpes simplex virus; HCV, hepatitis C virus; HIV, human immunodeficiency virus; HTN, hypertension; CVA, cerebrovascular accident.

^*Diagnostic criteria accuracy: how readily and accurately cases can be diagnosed. The ability to diagnose infection is high, whereas the ability to identify inadequate pelvis is limited due to difficulty of the definition.

^†Effect on prevention of first cesarean delivery: Small means that modification of indication (eg, infection) could lead to a small decrease in cesarean deliveries.