Risks and Complications of Cesarean Section
There are certain risks associated with a cesarean section which have to be kept in mind. This includes risks to the mother and risks to the baby.
Risks to Mother
- There are more chances of complications following childbirth in case of cesarean section delivery than in vaginal delivery.
- The recovery time is longer after cesarean section.
- Complications associated with any major surgery, such as hemorrhage (bleeding), wound infection, and injury to surrounding organs such as ureter, bladder and bowel.
- Uterine injury.
- Uterine atony – the uterus may not contract sufficiently following delivery.
- Anesthetic complications, including adverse reaction to anesthetic agents.
- Risk of developing blood clots in veins, such as DVT (deep vein thrombosis), with its more dangerous sequel of pulmonary embolism (blood clot in lung), which can be life-threatening. Early ambulation after surgery can help to prevent this complication.
- Urinary tract infection.
Risks to Baby
- Fetal injury – accidental cut by the scalpel (knife) on the presenting part, such as the scalp, during the procedure.
- Respiratory distress in the baby, especially when the cesarean is done before 39 weeks of pregnancy or before lung maturity of the fetus.
Risks in Future Pregnancies
- Although future vaginal delivery is possible after a cesarean section, the chances of cesarean section in later pregnancies are increased.
- Uterine rupture in subsequent pregnancy.
- Placenta previa.
- Placenta accreta, increta, or percreta – the placenta grows abnormally deep into the wall, which may lead to excessive bleeding after childbirth, and may require a hysterectomy.
Cesarean Section Procedure
Delivery of the baby by a cesarean section may be done either as an elective (planned) or an emergency procedure.
A cesarean section usually takes less than an hour to perform.
- It is preferable that the patient be on empty stomach to prevent pulmonary aspiration (aspiration of stomach contents into the trachea and lungs). Pre-operative emptying of the stomach is advisable.
- IV (intravenous) lines are introduced in a vein in the hand or arm.
- Blood is taken for cross matching, particularly in case of abruptio placentae and placenta previa, where blood transfusion may become necessary if there is excessive blood loss.
- A catheter is usually placed in the bladder before the start of the operation.
In most cases, regional anesthesia is given, either in the form of spinal block or epidural anesthesia. With this type of anesthesia, there will be no sensation in the lower part of the body but the patient will be awake throughout the operation.
In some cases, general anesthesia may be given. Here the patient will be totally unconscious throughout the operation.
After cleaning the abdomen with antiseptics and draping the area, the surgeon may give either of the 2 types of skin incisions for a cesarean section.
- Transverse Incision (lower uterine segment incision)
A transverse or horizontal skin incision (Pfannenstiel or Joel-Cohen Incision) is made just above the symphysis pubis (pubic bone), near the pubic hairline. Also known as the bikini cut, it is the most popular skin incision for a cesarean section. The advantages include better cosmetic results, less pain, and decreased chances of hernia formation.
- Vertical Incision (Classic cesarean section)
This incision is given in the midline, extending from just below the umbilicus (belly button) to just above the symphysis pubis. This type of incision is rarely given nowadays except in an emergency when the baby needs to be delivered quickly. A vertical incision allows quick entry into the abdominal cavity, with less amount of bleeding
- Following the abdominal incision, the rectus sheath is reached and opened, and the rectus muscles are separated in the midline by sharp and blunt dissection. The peritoneum is then identified.
- The bladder fold of the peritoneum is picked up and a transverse incision is given on it.
- By means of finger dissection, the bladder is separated from the anterior aspect (front) of the uterus and held away so as to prevent any injury.
- A transverse incision, about 2 cm long, is made through the anterior uterine wall, which is then extended in a crescent-shaped manner.
- In most cases, the baby is delivered by lifting up with the hand. If delivery becomes difficult, either one or both blades of forceps may be applied to deliver the baby.
- After the placenta has been delivered, the uterine incision is repaired in 1 or 2 layers with chromic catgut or absorbable synthetic suture. The abdomen is then closed in layers.
- The hormone oxytocin is given after birth of the baby to make the uterus contract and control bleeding. Antibiotics are given to prevent infection.
Cesarean Section Video
WARNING : The video below is graphic and sensitive viewers are advised.
In many cases, vaginal birth after cesarean section (VBAC) is possible in future pregnancies. If a woman is interested in VBAC, she should discuss the risks associated with both VBAC as well as repeat cesarean delivery with her doctor, who can advise what is best for her.
- Pain killers are given as necessary.
- About 3 to 4 liters of intravenous fluids is given in the first 24 hours.
- The catheter is usually removed 12 to 24 hours after surgery once the patient is walking.
- Early ambulation (walking about) is encouraged.
- Breastfeeding can be started within a few hours after delivery.
- The average hospital stay is 3 to 4 days after cesarean section but the mother and baby may be allowed to go home earlier if so desired and all is well.
- Staples used for skin alignment may be removed prior to discharge, or the mother may return after 2 or 3 days for staple or skin suture removal.
- Before discharge, advice about contraception should be given. It is necessary to explain to the mother that pregnancy is possible even if she is breastfeeding.
- Intercourse is best avoided for 4 to 6 weeks after the delivery.
- If there are no further complications, a follow-up consultation after 4 to 6 weeks is advisable.