Table 1.

Criteria for non-medically indicated caesareans ^a

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)

^aAll criteria are required

^bSigns of foetal distress: foetal heart rate abnormalities (<120 or >160 beats/min. or repeated decelerations); coloured amniotic fluid

^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