Cesarean Section – Indications, Types & Complicatons

Cesarean section is the delivery of a viable fetus through an abdominal incision and uterine incision. according to WHO it accounts for 10-15% of all deliveries.

It is the most common operative delivery in the world. it significantly increases globally due to increasing surgical safety, the introduction of electronic fetal monitoring, lack of skills for vaginal delivery. Read the step by step procedure here.

What are Indications

There are many indications to do C-section. it classified as

  • Maternal and
  • Fetal indications

Maternal Indication

  • Contracted pelvis
  • Pelvic tumor obstructing the passage
  • Pelvic fracture
  • Previous successful vaginal or perineal surgery for example surgery for stress incontinence, urinary fistula, major degree perineal tear repair…
  • Invasive carcinoma of the cervix
  • Previous 2 lower uterine segment c/s or 1 classical c/s or any uterine scar
  • Severe maternal hypertension
  • Antepartum hemorrhage – a major type of placenta previa, severe abruptio placentae
  • Cerebral aneurysm, arteriovenous malformation
  • Failed induction
  • Maternal HIV with a viral load greater than 1000 copies per mm2
  • Maternal active genital herpes and other STI infections

Fetal Indiction

  • Fetal distress
  • Macrosomia >5000g in non Diabetic mothers
  • Malpresentation – eg face, persistent brow, footling breach, compound, persistent occipital posterior, deep transverse arrest, transverse lie
  • Multiple gestations if the 1st baby is a nonvertex presentation
  • Fetal anomaly with dystocia
  • Nonreassuring fetal heart rate pattern
  • Cord prolapse

Type of Cesarean Section

Depend on the abdominal incision cesarean section can be classified as: –

  1. Lower transverse (Joel-cohen based method)
  1. Pfannenstiel
  1. Sub umbilical midline

Depend on the uterine incision cesarean section can be classified as: –

  1. Lower uterine segment incision

It is the most common type of c-section. it can be low transverse (misgave launch technique) or low vertical (De lee).


  • low bleeding
  • stronger scar formation so it decreases dehiscence and rupture
  • increase the risk of infection and adhesion
  • if extended it might cause a lot of bleeding
  1. Classical uterine incision

it is a vertical incision at the upper uterine segment.


  • if the lower segment not accessible (if it is not developed)
  • cancer of the cervix
  • pervious successful repair of vagino uterine fistula
  • when cesarean hysterectomy planned
  • if c/s done post mortem
  • transverse lie presentation
  • fetal malformation (sacrococcygeal tumor or severe hydrocephalus)
  • severe fetal distress (due to rapidity of the procedure)


  • increased blood loss
  • increase the risk of uterine rupture
Every Thing You Need To Know About Cesarean Section

How to Prepare For Elective Cesarean Section

Elective C-section is when you and your doctor schedule c/s before you start labor. it is not an emergency decision so you get a chance to get prepared before the procedure started.

  • fast for at least 8 hours. it decreases aspiration especially if the anesthesia is general anesthesia type
  • updated hg, blood group, and RH type is needed then prepare at least 2 unit of whole blood to incase the patient need it
  • catheterize the patient to empty the urinary bladder. it decreases injury to the bladder during the procedure
  • pre-anesthesia assessment
  • preop prophylactic antibiotic
  • consent form

Post-op care

  • follow the patient vital sign
  • incision dressed and covered
  • early ambulation is needed to decrease thrombotic risk. because these patients have many risks like decrease ambulation, surgery, pregnancy…
  • diet stared form clear fluid 8 hours after surgery
  • adequate pain management
  • suture removal 4th – 5th POD.

What are the Complications

Compare to vagnal delivery, maternal mortality in c/s increased by 12X due to anesthesia complications, aspiration pneumonia, hemorrage, and sepsis.

Complications can be classified into immediate and late.

Immediate complications

  • increased risk of postpartum hemorrhage
  • intrapartum injury to other organs like ureter, bowel, urinary bladder
  • postpartum fever
  • anesthetic problem

Late complications

  • intraabdominal adhesion
  • scar dehiscence
  • incisional hernia
  • increased risk of uterine rupture, placenta previa, a morbid adherent of the placenta, difficult c/s in a subsequent pregnancy

What is VBAC?

VBAC or trial of the scar is a vaginal birth after one previous c/s. VBAC has a 75% success rate.

Prerequisites for VBAC are: –

  • single prior lower uterine c/s
  • singleton, term, cephalic fetus
  • Efw < 3500 g
  • spontaneous labor
  • no grossly contracted pelvis
  • 1-1 labor monitoring access esp electronic fetal monitoring
  • emergency c/s should exist in the facility
  • mother must be willing to give a try

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