Cesarean section

Last revised by Dr Joshua Yap on 28 Jul 2022

Cesarean section (also known as C-section, CS and C/S) is the most frequently done major abdominal surgery in females, performed to deliver a baby as an alternative to normal vaginal delivery 1

Many forms of cesarean section have been described, but the most popular variation is the low transverse approach following a Pfannenstiel or Joel-Cohen skin entry. Following sharp skin opening, blunt dissection down to the fascia is performed. After this, a transverse incision of the fascial layer is done, with subsequent blunt division of the rectus abdominis muscles and then careful access into the peritoneal cavity. This is to reduce the risk of accidental iatrogenic trauma to the proximate organs, e.g. bowel, bladder, etc. This dissection is considerably more difficult if pre-existing adhesions are present.

Before entry into the uterus, the surgeon assesses the fetal lie, then makes a short, low, transverse cut through the myometrium in the lower uterine segment. Thus these procedures are often referred to as a "lower segment cesarean section (LSCS)". Occasionally a vertical incision is performed instead, a so-called “classical cesarean incision". The baby is delivered using extrinsic uterine pressure, with the attached placenta following.

After delivery, the myometrium is repaired using a single or double suture layer. Closure of the fascial and skin layers follows. The peritoneum may or may not be closed, but the abdominal wall muscles are usually left divided 1.

Acute:

Chronic:

The term was first utilized in 715 BC under the Roman legislation ‘Lex Caesare’ (imperial law), which decreed that a baby should be cut from the womb of a woman who dies during late pregnancy. The term has since been erroneously attributed to Gaius Julius Cesar (100-44 BC) who was traditionally believed to have been born by this method, a speculation that has since been proven false 3. The word ‘cesarean’ is therefore written in lowercase.

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