Caesarean Section

Indication :

• Previous caesarean section or myomectomy

• CPD or slow progress

• Failed induction

• Malpresentation (Breech, oblique transverse lie)

• Fetal distress or abnormal fetal well being

• Macrosomia / Intrauterine Restriction

• Previous uterine scar

• Multiple Pregnancies

• Pregnancy Induced Hypertension / Pre-eclampsia

• Gestational Diabetes

• Advanced Maternal Age

• Self-request

Nature of operation

• Regional / general anaesthesia

• Suprapubic transverse skin incision

• Peritoneal cavity entered

• Bladder separated from uterus

• Uterine incision

• Delivery of baby (may use forceps) and placenta

• Uterine wound and abdominal wound closed

Benefits of the procedure

• For delivery of baby when vaginal delivery is not suitable and for well being of mother or baby

Other consequences after the Procedure

• For classical Caesarean section, there is a definite need for future Caesarean

• For lower segment caesarean section, there may be a need for future Caesarean

• Higher risk of placenta praevia, placenta accreta, percreta in subsequent pregnancies.

Risks and complications may include, but are not limited to the following:

• Anaesthetic complications e.g: nausea and vomiting, allergic reactions to medications, difficulty in breathing, lung infection. The anaesthetist will explain these risks to you again before the surgery. Regional Anaesthesia complications may include e.g: local discomfort, swelling and bruising, headache.

• Bleeding, may need blood transfusion, or even pelvic vessel embolization or hysterectomy as a means of life-saving procedure when bleeding is uncontrolled

• Injuries to adjacent organs e.g. bladder, rarely to ureters, bowels, may require further surgery.

• Infection of the uterus

• Wound complications such as infection, haematoma, gaped wound requiring resuture, or hernia

• Deep vein thrombosis in patients with prolonged immobilization, obesity and those with risk factors. This problem is rare in Chinese population

• Amniotic Fluid Embolism – is rare, occurring in one in 8,000 to 80,000 deliveries. The clinical picture develops with stunning rapidity. The amniotic fluid enters the circulation system, and produces a massive perfusion failure, massive bleeding and shock. Death rate can be up to 70%.

• Accidental injury to infant, skin lacerations

• Transient tachypnoea of the newborn, respiratory distress syndrome

• Perinatal anoxia

• Birth injury: for example Fractures

Risks of not having the procedure

• Well being of baby or mother may be affected if the procedure is delayed, and when vaginal delivery is not suitable

Possible alternatives

• Vaginal delivery including waiting for spontaneous onset on labour or instrumental delivery by vacuum extraction or forceps

• In breech presentation, one can consider external cephalic version. Trial of vaginal delivery for term breech carries a significantly higher neonatal morbidity and mortality.

• In case of trial of scar, there is a small risk of scar rupture (around 1% for previous lower segment Caesarean; 4.7% for previous classical Caesarean). More than 60% women have successful vaginal delivery. Failing this, one will need an emergency Caesarean section

Other associated procedures which may become necessary during the procedure

• Blood transfusion

• Embolization of pelvic vessels or hysterectomy as a life-saving procedure in case of uncontrolled bleeding

• May perform surgery on tubes, ovaries or other adnexal organs if abnormality is found

Any special follow up

• Postpartum check-up is required, just like the case of normal vaginal delivery