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
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Regional / general anaesthesia
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Suprapubic transverse skin incision
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Peritoneal cavity entered
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Bladder separated from uterus
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Uterine incision
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Delivery of baby (may use forceps) and placenta
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Uterine wound and abdominal wound closed
Benefits of the procedure
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For delivery of baby when vaginal delivery is not suitable and for well being of mother or baby
Other consequences after the Procedure
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For classical Caesarean section, there is a definite need for future Caesarean
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For lower segment caesarean section, there may be a need for future Caesarean
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Higher risk of placenta praevia, placenta accreta, percreta in subsequent pregnancies.
Risks and complications may include, but are not limited to the following:
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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.
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Bleeding, may need blood transfusion, or even pelvic vessel embolization or hysterectomy as a means of life-saving procedure when bleeding is uncontrolled
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Injuries to adjacent organs e.g. bladder, rarely to ureters, bowels, may require further surgery.
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Infection of the uterus
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Wound complications such as infection, haematoma, gaped wound requiring resuture, or hernia
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Deep vein thrombosis in patients with prolonged immobilization, obesity and those with risk factors. This problem is rare in Chinese population
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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%.
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Accidental injury to infant, skin lacerations
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Transient tachypnoea of the newborn, respiratory distress syndrome
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Perinatal anoxia
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Birth injury: for example Fractures
Risks of not having the procedure
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Well being of baby or mother may be affected if the procedure is delayed, and when vaginal delivery is not suitable
Possible alternatives
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Vaginal delivery including waiting for spontaneous onset on labour or instrumental delivery by vacuum extraction or forceps
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In breech presentation, one can consider external cephalic version. Trial of vaginal delivery for term breech carries a significantly higher neonatal morbidity and mortality.
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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
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Blood transfusion
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Embolization of pelvic vessels or hysterectomy as a life-saving procedure in case of uncontrolled bleeding
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May perform surgery on tubes, ovaries or other adnexal organs if abnormality is found
Any special follow up
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Postpartum check-up is required, just like the case of normal vaginal delivery
