A 30-year-old primigravida at 39 weeks is found to have an uncomplicated singleton breech presentation. External cephalic version has failed and she is not in labour. The pregnancy is otherwise normal. Which caesarean urgency category does her planned delivery fall into?

Answer: D. Category 4 - elective

Elective (category 4) caesarean indications

A planned term singleton breech, with no maternal or fetal distress and timing chosen to suit mother and staff, is a category 4 (elective) caesarean.

Category-4 indications

• Term singleton breech (after failed or declined ECV).
• Twin pregnancy with a non-cephalic first twin.
• Maternal HIV or primary genital herpes in the third trimester.
• Placenta praevia.
• Previous classical caesarean or previous hysterectomy.

Contrast with the urgent categories

Category 4 means there is no current compromise - delivery is timed for convenience and optimal staffing. This differs from category 3 (early delivery needed but no distress, e.g. severe pre-eclampsia) and the genuinely emergency categories 1 and 2.

Adjacent learning - the breech pathway

For an uncomplicated term breech not in labour, ECV is offered first (from around 36-37 weeks); if it fails or is declined, elective caesarean is planned. The picture changes if labour and fetal compromise supervene, which would raise the urgency category.