Information Sheet for 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


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

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