Previous caesarean section or myomectomy
CPD or slow progress
Malpresentation (Breech, oblique transverse lie)
Fetal distress or abnormal fetal well being
Macrosomia / Intrauterine Restriction
Previous uterine scar
Pregnancy Induced Hypertension / Pre-eclampsia
Advanced Maternal Age
Regional / general anaesthesia
Suprapubic transverse skin incision
Peritoneal cavity entered
Bladder separated from uterus
Delivery of baby (may use forceps) and placenta
Uterine wound and abdominal wound closed
For delivery of baby when vaginal delivery is not suitable and for well being of mother or baby
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.
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
Birth injury: for example Fractures
Well being of baby or mother may be affected if the procedure is delayed, and when vaginal delivery is not suitable
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
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
Postpartum check-up is required, just like the case of normal vaginal delivery