Obstetrics and Gynecology: Cesarean Section

Definition and Indications

• Cesarean section is a delivery method that involves abdominal and uterine incisions.
• Maternal indications for cesarean section include previous CS, previous uterine surgery, placenta previa/accreta, failed progress of labor, obstructed labor, and certain medical conditions.
• Fetal indications include fetal distress, malpresentation, malposition, macrosomia, and severe intrauterine growth restriction.

Types of Cesarean Section

• Lower segment cesarean section is the recommended procedure.
• Upper segment cesarean section, also known as classical cesarean section, is only used in selected cases.

Categories of Cesarean Section

• Category 1: immediate threat to the life of the woman or fetus, with a time limit of 30 minutes.
• Category 2: maternal or fetal compromise that is not immediately life-threatening, with a time limit of 60-75 minutes.
• Category 3: no maternal or fetal compromise, but needs early delivery, with no strict time limit.
• Category 4: elective, with a timed delivery to suit the woman or staff.

Steps of Cesarean Section

• Step 1: skin incision.
• Step 2: opening the anterior abdominal wall.
• Step 3: opening the uterus.
• Step 4: delivery of the baby and placenta.
• Step 5: closure of incisions.

Complications of Cesarean Section

• Hemorrhage (postpartum hemorrhage).
• Infection.
• Shock.
• Trauma to the fetus.
• Respiratory complications.
• Venous thrombosis (DVT).
• Postoperative anesthetic complications, such as cyanosis and vomiting.
• Long-term risks in subsequent pregnancies.