Which of the following is one of the absolute indications for a classical Caesarean section?

UPUMS Nsg officer-2023

Obstetrics & Gynaecology

Easy

Appeared in: UPUMS Nsg officer-2023

Explanation

A classical Caesarean section involves a vertical incision in the upper, active segment of the uterus, which is more muscular and vascular.
This procedure is absolutely indicated in cases of complete anterior placenta praevia, where the placenta covers the standard incision site on the lower uterine segment.
Making the incision in the upper segment avoids cutting through the placenta, which would cause massive, life-threatening hemorrhage for both the mother and fetus.
Other absolute indications include a transverse fetal lie (especially back-down), or large fibroids or dense adhesions obstructing the lower uterine segment.

Option A: Fetal distress is a common indication for an emergency Caesarean section, but the standard and preferred procedure is the Lower Segment Caesarean Section (LSCS), which is quicker and has lower morbidity.
Option C: Cephalopelvic disproportion (CPD) is a mismatch between the fetal head size and the maternal pelvis. It is a standard indication for an LSCS, not a classical incision.
Option D: A 'bad obstetric history' (e.g., previous stillbirth or difficult delivery) may lead a clinician to recommend an elective Caesarean delivery to ensure fetal safety. However, the procedure performed would be an LSCS.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Indications for Classical Caesarean Section as background academic context rather than a clinical decision trigger.
Nurses must understand the difference between C-section types because postoperative care, patient education, and risks for future pregnancies vary significantly.
A patient with a classical C-section scar has a much higher risk of uterine rupture in subsequent pregnancies (4-9%) compared to an LSCS scar (less than 1%).
Consequently, a trial of labor after a classical C-section (TOLAC) is contraindicated. These patients must be counseled that all future deliveries will require a repeat Caesarean section.

How to Approach the Question

First, identify the key terms in the question: 'absolute indications' and 'classical Caesarean section'.
Recognize that a classical C-section is a specific, less common type of uterine incision reserved for situations where the standard lower segment incision is not feasible or safe.
Evaluate each option. Ask yourself: 'Does this condition make it physically impossible or extremely dangerous to cut into the lower part of the uterus?'
Fetal distress, CPD, and a bad obstetric history are reasons to perform a C-section, but they do not physically block the lower uterine segment. Therefore, a standard LSCS would be used.
A complete anterior placenta praevia physically covers the area of the standard LSCS incision. Cutting there would mean cutting through the placenta, causing severe bleeding. This makes a classical incision an absolute necessity.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 40-58