NICE NG192: Caesarean Birth
Overview
NG192 covers the benefits and risks of caesarean birth versus vaginal birth, indications for planned caesarean birth, maternal request, procedural technique, and care before, during, and after caesarean birth, including recovery and future pregnancy planning. It supersedes the earlier CG132 guideline.
Indications for Planned Caesarean Birth
- Breech presentation: discuss the benefits and risks of planned vaginal birth versus planned caesarean birth; offer external cephalic version (ECV) as an alternative to planned caesarean birth where appropriate.
- Twin/triplet pregnancy: mode of birth decisions are cross-referenced to the separate NICE guideline on twin and triplet pregnancy.
- Placenta praevia: offer caesarean birth to women whose placenta partly or completely covers the internal cervical os.
- Previous caesarean birth: discuss planned vaginal birth after caesarean (VBAC) versus repeat planned caesarean birth, with appropriate intrapartum monitoring if VBAC is chosen.
- Maternal request: if a woman requests a caesarean birth after discussion of the overall benefits and risks compared with vaginal birth, and after exploring and addressing the reasons for the request (including anxiety), her choice should be supported, with the caesarean offered within her obstetric unit or via referral if the original team is unwilling to perform it.
Categorisation of Urgency
NG192 sets out a standardised four-category classification for caesarean birth urgency:
| Category | Definition | |----------|------------| | Category 1 | Immediate threat to the life of the woman or fetus (e.g. suspected uterine rupture, major placental abruption, cord prolapse, fetal hypoxia or persistent fetal bradycardia) | | Category 2 | Maternal or fetal compromise that is not immediately life-threatening | | Category 3 | No maternal or fetal compromise, but needs early birth | | Category 4 | Birth timed to suit the woman or healthcare provider |
Decision-to-Delivery Intervals
- Category 1: perform as soon as possible, and in most situations within 30 minutes of the decision being made.
- Category 2: perform as soon as possible, and in most situations within 75 minutes of the decision being made.
These are described as target intervals for most situations rather than absolute thresholds — clinical judgement on the individual case still applies.
Care After Caesarean Birth (Enhanced Recovery)
- Eating and drinking: women recovering well without complications can eat and drink as normal.
- VTE thromboprophylaxis: should be offered to women having a caesarean birth, with the approach individualised to risk factors.
- Urinary catheter: offer removal once the woman is mobile after a regional (neuraxial) anaesthetic, but no sooner than 12 hours after the last epidural/spinal "top-up" dose.
- Post-anaesthesia monitoring: after general anaesthesia, continuous observation until the airway is controlled, followed by monitoring appropriate to recovery; after neuraxial anaesthesia, monitoring is tailored to the opioid used and individual risk factors.
- Discharge from hospital: women who are recovering well, are apyrexial, and have no complications can be offered discharge after 24 hours, with follow-up at home — this is not associated with increased readmission rates for mother or baby.
High-Yield Exam Points
- Category 1 = immediate threat to life (uterine rupture, cord prolapse, major abruption, persistent bradycardia) → decision-to-delivery target within 30 minutes.
- Category 2 = compromise present but not immediately life-threatening → decision-to-delivery target within 75 minutes.
- Category 3 = no compromise but needs early birth; Category 4 = elective, timed to suit woman/unit.
- The 30-minute (Cat 1) and 75-minute (Cat 2) intervals are the classic recalled exam figures — know these as targets "in most situations," not rigid cut-offs.
- Placenta praevia covering the internal os → caesarean is offered (not vaginal birth).
- Maternal request alone, after informed discussion, is a valid indication for caesarean birth.
- Urinary catheter after regional anaesthesia: remove once mobile, but not sooner than 12 hours post last top-up dose.
- Uncomplicated recovery → normal diet resumed early, and discharge can be offered at 24 hours.
MRCOG AI is an independent educational tool. It is not affiliated with, endorsed by, or connected to the Royal College of Obstetricians and Gynaecologists (RCOG) or NICE. Always consult the current NICE guideline (nice.org.uk/guidance/ng192) for full recommendations.
Source: National Institute for Health and Care Excellence (NICE) (10 June 2025 (originally published 31 March 2021))
Read the original on nice.org.uk
MRCOG AI is an independent educational tool. It is not affiliated with, endorsed by, or connected to the Royal College of Obstetricians and Gynaecologists (RCOG).