Cesarean Section: Anatomy, Indications, Procedure, and Risks

Uterine Anatomy

• Corpus (body) and cervix.
• Layers: endometrium (inner), myometrium (muscle), serosa (outer peritoneal covering).

Cesarean Delivery

Surgical birth via abdominal and uterine incisions when vaginal delivery risks maternal/fetal health.

Common Indications

• Fetal distress (non-reassuring tracing)
• Malpresentation (breech, transverse)
• Placenta previa, abruption
• Preeclampsia/eclampsia
• Failed induction, arrest of labor
• Prior classical uterine incision, multiple prior C-sections
• Maternal request (after counseling)

Procedure (Pfannenstiel/Kerr typical)

1. Regional anesthesia (spinal/epidural) preferred.
2. Transverse skin incision → fascia → rectus separation → peritoneum.
3. Low transverse hysterotomy (lower uterine segment).
4. Delivery of infant, cord clamping, placental removal.
5. Uterine closure (1–2 layers), peritoneal, fascial, skin closure.

Risks

• Infection (endometritis, wound), hemorrhage, thromboembolism
• Organ injury (bladder, bowel, ureter)
• Future risks: uterine rupture, placenta accreta spectrum, C-section scar ectopic
• Neonatal: transient tachypnea (less lung fluid clearance)

Recovery

2–4 day hospitalization; 6–8 weeks for full healing. Early mobilization, thromboprophylaxis, pain multimodal, breastfeeding support.