Caesarean section

Caesarean section

Caesarean section involves making an abdominal skin incision and an incision over the lower segment of the uterus to deliver the baby. 

Common reasons for doing a Caesarean section are previous Caesarean section, breech presentation, some cases of multiple pregnancies, fetal distress during labour, and poor progress during labour. It is generally a safe procedure and complications are uncommon. In some patients may have a greater risk of complications because of other medical or obstetric conditions. 

Complications include: 

During or soon after operation

• Excessive bleeding - This may occur if the uterus does not contract well or it could occur from the abdominal or uterine incision. Blood transfusion may be required.
• Infection - Infection may occur in the uterus or abdominal wound, and antibiotics may be required to treat this.
• Injury to other organs such as bladder, bowel or ureter - This is rare but the risk increases if there had been previous abdominal surgery. If there is any injury, further surgery may be required to repair the injury.
• Retained products of conception - A portion of placenta and amniotic membranes may be firmly adherent to the inner wall of the uterus after the operation.  This may cause excessive bleeding or infection after the operation.  If there is continuous bleeding or infection within 6 weeks of the pregnancy, an ultrasound scan may be performed to diagnose the condition.  Treatment may involve medication to contract the uterus further in an attempt to dislodge the products, or surgery to evacuate the uterus may be performed.
• Thromboembolism (formation of blood clots in the leg veins that may dislodge) - This may occur due to the changes of pregnancy and immobility, and prophylactic measures such as leg exercises and early ambulation would reduce the risk. If it occurs, treatment is necessary to dissolve the blood clots. If the clot dislodges and travels to the lung (pulmonary embolism), this can be life threatening.
• Excessive scar formation (keloid) and scar pain - Keloids can form due to excessive scar formation. Care of the wound and use of certain creams may reduce the occurrence.

• Adhesions formation - Adhesions to the bowel may form after any abdominal surgery. If the adhesions involve the tubes, this may affect fertility in future.

Risks in the next pregnancy

• Risk of uterine scar rupture in a subsequent pregnancy - As there is a scar on the uterine wall, there is a small risk of this scar giving way (scar rupture) during labour if undergoing a trial of vaginal birth in a subsequent pregnancy.
• Risk of adherent placenta in a subsequent pregnancy (placenta accreta) - Rarely, the placenta may grow into the uterine scar in a subsequent pregnancy, and this may result in severe bleeding at the time of delivery.
• Increased risk of unexplained stillbirth in a subsequent pregnancy - when compared to previous vaginal birth.

Caesarean section may be performed under regional anaesthesia (like spinal analgesia or epidural analgesia) or general anaesthesia. In general, regional anaesthesia is usually preferred over general anaesthesia as the mother is awake during the operation, bonds better with the baby (as the mother is able to see and hold the baby), and experiences less difficulty with breastfeeding.