Complications of Cesarean Deliveries

Introduction

Largely since the advent of electronic fetal monitoring, which was first introduced in the late 1960s and had become routine by the 1980s, there has been a dramatic rise in the number of cesarean deliveries, and the issue of when to perform a cesarean section has become a central focus of obstetrics. In addition to electronic fetal monitoring, other factors have contributed to this trend, including changing guidelines regarding a trial of labor after a prior cesarean delivery, fear of medical malpractice lawsuits, and, most recently, patient requests for elective cesarean deliveries. Unfortunately, much of the change in practice related to cesarean delivery has not been supported by evidence-based medicine; nor has there been a demonstrated improvement in neonatal outcomes with increasing rates of cesarean delivery.

This article does not address specific indications for performing cesarean sections. Instead, it aims to inform healthcare providers of some of the documented risks for complications of cesarean section. With the increasing rate of cesarean deliveries, providers will see more and more of these complications. It is also critical for the provider and the patient to be aware of the risks for complications so that they can make informed decisions about the best mode of delivery given the individual clinical situation they face.

For patients interested in learning more about these risks and benefits of cesarean delivery compared with vaginal delivery, I recommend that they visit http://www.childbirthconnection.org. This site is maintained by the Childbirth Connection (formerly Maternity Center Association) and offers a downloadable booklet for patients, "What Every Pregnant Woman Needs to Know About Cesarean Section," which encompasses much of the data discussed in this article in a patient-friendly format. In addition, the Sidebar contains links to the methods and sources used to develop the booklet and patient information.

It is difficult to make generalizations about whether a vaginal or cesarean delivery is the better mode of delivery. The circumstances a clinician faces are unique with each woman and with each of her pregnancies. These include not only the clinical circumstances encountered during a given pregnancy but also the patient's attitudes, concerns, and wishes. Nevertheless, there is a large literature of epidemiologic data on the outcomes related to mode of delivery that can help the provider guide a patient and her family through a risk-benefit decision-making process to choose the optimal mode of delivery in a given clinical situation.