Indications for Cesarean section during laparotomy for trauma include:

b. Unstable thoracolumbar spinal injury

c. Mechanical limitation for maternal repair

d. Maternal death if estimated gestational age is at least 28 weeks

The indications for exploratory laparotomy in a pregnant patient are the same as in all other trauma patients. However, Cesarean section should not be added unless indicated due to the prolongation of operative time and the increase in blood loss (approximately 1 liter). Vaginal delivery is always encouraged even in the postoperative period. During laparotomy for trauma, indications for Cesarean section are as follows:

1. Maternal shock, pregnancy near term

2. Threat to life from exsanguination

3. Mechanical limitation for maternal repair

4. Risk of fetal distress exceeding risk of prematurity

5. Unstable thoracolumbar spinal injury

The outcome of postmortem C-section depends on the duration of the gestation and the time interval between maternal death and delivery. Under optimal conditions, at 26 to 28 weeks gestation, estimated fetal survival is about 50%. Postmortem C-section is justified if the estimated age is about 26—28 weeks. If the time interval between maternal death and delivery is less than 5 minutes, the fetal prognosis is considered excellent. If the time interval since maternal death is prolonged to about 20 minutes, fetal prognosis is poor.