كتاب
Rationalizing the use of caesarean section in Egypt through implementing 10 group Classification system
- May cesarean section be regarded as an alternative to spontaneous delivery?
To answer this question which is a common one in practice nowadays? Two issues will be discussed (15)
A- a cesarean section remains a surgical operation, and as such it also has side effects and complications
B- Comparison of complications of elective cesarean section and planned vaginal delivery
( A ) Complications of CS
Cesarean section remains a surgical operation, and as such it also has complications that can be intraoperative, post-operative or complications in subsequent pregnancies
Intraoperative complications
· Infections
· Organ injury (bladder, intestines, ureter, etc.)
· Risks associated with anesthesia
· Need for blood transfusions
· Hysterectomy as a treatment for severe bleeding, e.g. from p lacenta praevia Postoperative complications
· Thromboembolic complications (embolism, thrombosis)
· Adhesions
· Persistent pain
Complications in subsequent pregnancies
· Intrauterine growth retardation and preterm delivery
· Spontaneous abortion
· Ectopic pregnancy
· Stillbirth
· Uterine rupture
· Infertility
· Placenta previa and Morbidly adherent Placenta
( B ) Comparison of complications of elective cesarean section and planned vaginal delivery
The data are based on the NICE guideline, in which the few prospective studies that exist were evaluated according to the criteria of evidence-based medicine (EBM).
i. Risks reduced after elective cesarean:
– Abdominal and perineal pain during the birth
– Abdominal and perineal pain 3 days after the birth
– Vaginal injuries
– Anesthesia-related emergencies (shock, bleeding)
ii. Risks reduced after vaginal delivery
– Duration of hospital stay
– Hysterectomy due to postpartum bleeding
– Cardiac arrest
iii. No differences
– Abdominal and perineal pain 4 months after the birth
– Injuries to nearby organs (bladder, ureter, or cervix)
– Pulmonary embolism
It is documented that Maternal morbidity in elective cesareans is only slightly higher than that for vaginal deliveries however the remote effects on subsequent pregnancies carry more morbidities especially with morbid adherent placenta meaning that planned elective cs is not alternative to vaginal delivery on the other hand c should be used in indicated cases .(26)
