Advanced maternal age (women are more career inclined, hence delaying marriage and conception )

Increase in repeat c-sections

Delivering most breech presentation by c/s

Increased diagnosis of intrapartum fetal distress with increase use of intrapartum monitoring tools 

Destructive operations are abandoned in favour of c/s

High forceps and difficult mid forceps are abandoned for c/s

Identification of risks in mothers and fetuses

Increase in pregnancies by in-vitro fertilization (babies are too precious to be allowed to go through the stress of labour)

Attempts to reduce perinatal and maternal mortality

Maternal request / demand

Concern for litigation (especially when malpractice is of concern)

Maternal:

• More than 2 previous Cesarean sections
• Preeclampsia with unfavourable cervix
• Prolonged labor with suspected cephalopelvic disproportion
• Obstructive lesions in the lower genital tract eg malignancies and leiomyoma
• Previous extensive uterine surgery (myomectomy)
• Previous VVF repair 
• Previous reconstructive vaginal surgery 
• Large vulva condylomata
• Active vulva herpes simplex virus

• Persistent abnormal lie or non-vertex presentation at term
• Multiple pregnancies: the first twin in a non-vertex presentation, or higher order multiples
• Some congenital anomalies eg hydrocephalus
• Fetal distress
• Cord prolapse
• Fetal macrosomia

• Placenta praevia
• Cephalopelvic disproportion

• Failure to progress in labour (CPD, malposition, malpresentation) 
• Fetal distress (especially in  first stage of labour)
• Imminent uterine rupture
• Cord prolapse (in first stage of labour)
• Cord presentation
• Placenta praevia ( bleeding out of proportion irrespective of gestational age, at or near term)
• Abruptio placenta with live babies

• Preoperative laboratory testing (Complete blood cell count, blood group and cross-match, screening tests for human immunodeficiency virus, hepatitis B and hepatitis C)
• Evaluation by the senior obstetrician, anesthesiologist and neonatologist,
• Theatre team preparation and readiness for the surgery

Scrubbing and gowning by the surgeon

Administering of Anaesthetic agent( regional or general depending on the required speed to knock the patient off for the peculiarity of the surgery) by the Anaesthetist

Cleaning and draping of patient

Abdominal incisions, (depending on the required speed  or the technicalities involved to gain access into the peritoneal cavity)  

1. Pfannenstiel incision
2. Joel Cohen incision
3. Pelosi incision
4. Maylard incision
5. Cherny incision

Subumbilical vertical midline incision

Uterine incisions

1. low transverse incision
2. Classical incision
3. low vertical incision
4. J-shaped incision
5. T- shaped incision
6. U-shaped incision

• Delivery of fetus and handing over to the neonatologist, delivery of placenta and control of haemorrhage
• Wound closure (uterine and the anterior abdominal wall in layers) and application of wound dressing
• Perineal cleaning and routine passage of rectal uterotonics
• For General Anaesthesia, there is need for reversal of anaesthesia

• Administration of fluids and medications (antibiotics, analgesics, oxytocics and other medications depending on the peculiarities of the patient) according to postoperative order
• Ambulation on postoperative day 1
• Wound check and hematocrit check on day 2
• Discharge on postoperative day 3, if no complications 
• Contraception options to prevent unintended pregnancy are discussed before discharge, unless the patient had long acting contraception placed at the time of the procedure.

Some complications that may arise with Cesarean section include anaesthetic complications, hemorrhage, sepsis, injury to contiguous structures, pain, hysterectomy and death