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Cesarean Justification Form

Cesarean Delivery Justification & Accountability Form

Required documentation for every cesarean delivery. Structured, evidence-based, and reviewer-ready.

Evidence Base & Regulatory Context

  1. ACOG Practice Bulletin No. 764 (2019). Medically Indicated Late-Preterm and Early-Term Deliveries. Obstet Gynecol. 2019;133(2):e151–e163. Defines evidence-based thresholds for delivery by indication.
  2. Boyle A, Reddy UM, Landy HJ, et al. Primary cesarean delivery in the United States. Obstet Gynecol. 2013;122(1):33–40. Establishes that non-indicated cesareans drive NTSV rate variability.
  3. Caughey AB, Cahill AG, Guise JM, Rouse DJ. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014;210(3):179–193. ACOG/SMFM Consensus — defines rigorous clinical thresholds for each indication category.
  4. WHO Statement on Cesarean Section Rates (2015). Cesarean section rates >10–15% at population level are not associated with reduced maternal/neonatal mortality.
  5. Lagrew DC, Low LK, Brennan R, et al. National Partnership for Maternal Safety: Consensus Bundle on Safe Reduction of Primary Cesarean Births. Obstet Gynecol. 2018;131(3):503–513.
  6. RCOG Good Practice No. 11 (2010). Classification of urgency of caesarean section. Royal College of Obstetricians and Gynaecologists.
  7. ACOG Committee Opinion No. 761 (2019). Cesarean Delivery on Maternal Request. Obstet Gynecol. 2019;133(1):e73–e77.
  8. ACOG Practice Bulletin No. 205 (2019). Vaginal Birth After Cesarean Delivery. Obstet Gynecol. 2019;133(2):e110–e127.
Patient & Clinical Identifiers Required
Urgency Classification Required

Royal College of Obstetricians and Gynaecologists (RCOG) four-tier classification. Classification of urgency of caesarean section. Good Practice No. 11. RCOG; 2010.

Cat 1
Immediate
Immediate threat to life of mother or fetus — Decision to incision <30 min
Cat 2
Urgent
Maternal/fetal compromise, not immediately life-threatening
Cat 3
Scheduled Urgent
Early delivery needed; no immediate compromise
Cat 4
Elective
At a time to suit patient and team
Clinical Indication(s) At least one required
Fetal Indications
Labor Progress Indications
Maternal Indications
Repeat Cesarean / Other Indications
Clinical Narrative & Decision Summary Required
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Cesarean Delivery Justification Record

Patient ID / MRN
Delivery Date & Time
Age / Gravida / Para
Gestational Age / CS Type / Labor
Attending
Urgency Category
Documented Indication(s)
Clinical Narrative
Conservative measures attempted
Informed consent
Senior discussion / Neonatal notification
Form generated: · ObGyn Intelligence — tools.obmd.com · Amos Grünebaum, MD · obmd.com