Caesarean birth: indications, technique, complications

You are the registrar. The phone says "category 1, room 4, prolonged bradycardia" and you are already walking. In the ninety seconds it takes to reach theatre you should have answered four questions: how urgent is this really, what is the placenta doing, what is the presentation, and who else needs to be in the room. Caesarean birth is the commonest major operation performed on women anywhere in the world, and the marks are in the ordinary steps done exactly right.^[1][5]

Overview and definition

A caesarean birth delivers the baby through incisions in the abdominal wall and the uterus. The operation itself has been stable for a century; what fellowship examines is everything around it — the urgency decision, the consent numbers, the prophylaxis, the difficult variants and the consequences for the next pregnancy.^[1][18]

Two framings you should be able to switch between: ^[1][18]

• By timing: planned (prelabour, scheduled) versus unplanned (intrapartum or emergent before the scheduled date).^[1]
• By uterine incision: low transverse, low vertical, classical, and the unintended inverted-T or J extension — because each of those determines what she can be offered next time.^[18]

References21ShowHide

1. [1]Lucas DN, Yentis SM, Kinsella SM, et al. Urgency of caesarean section: a new classification J R Soc Med, 2000.PMID 10928020
2. [2]Abalos E, Addo V, Brocklehurst P, et al. Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial Lancet, 2013.PMID 23721753
3. [3]Mathai M, Hofmeyr GJ, Mathai NE Abdominal surgical incisions for caesarean section Cochrane Database Syst Rev, 2013.PMID 23728648
4. [4]Dodd JM, Anderson ER, Gates S, et al. Surgical techniques for uterine incision and uterine closure at the time of caesarean section Cochrane Database Syst Rev, 2014.PMID 25048608
5. [5]Smaill FM, Grivell RM Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section Cochrane Database Syst Rev, 2014.PMID 25350672
6. [6]Mackeen AD, Packard RE, Ota E, et al. Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery Cochrane Database Syst Rev, 2014.PMID 25479008
7. [7]Tita AT, Szychowski JM, Boggess K, et al. Adjunctive Azithromycin Prophylaxis for Cesarean Delivery N Engl J Med, 2016.PMID 27682034
8. [8]Haas DM, Morgan S, Contreras K, et al. Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections Cochrane Database Syst Rev, 2020.PMID 32335895
9. [9]Waterfall H, Grivell RM, Dodd JM Techniques for assisting difficult delivery at caesarean section Cochrane Database Syst Rev, 2016.PMID 26827159
10. [10]Cornthwaite K, van der Scheer JW, Kelly S, et al. Management of impacted fetal head at cesarean birth: A systematic review and meta-analysis Acta Obstet Gynecol Scand, 2024.PMID 38787368
11. [11]Sadler LC, Thompson JMD, Alsweiler JM, et al. Maternal and neonatal morbidity associated with Fetal Pillow use at full dilatation caesarean: A retrospective cohort BJOG, 2024.PMID 38287196
12. [12]Tuuli MG, Rampersad RM, Carbone JF, et al. Staples compared with subcuticular suture for skin closure after cesarean delivery: a systematic review and meta-analysis Obstet Gynecol, 2011.PMID 21343772
13. [13]Caughey AB, Wood SL, Macones GA, et al. Guidelines for intraoperative care in cesarean delivery: Enhanced Recovery After Surgery Society Recommendations (Part 2) Am J Obstet Gynecol, 2018.PMID 30118692
14. [14]Mackeen AD, Sullivan MV, Berghella V Evidence-based cesarean delivery: preoperative management (part 7) Am J Obstet Gynecol MFM, 2024.PMID 38574855
15. [15]Mackeen AD, Sullivan MV, Bender W, et al. Evidence-based cesarean delivery: postoperative care (part 10) Am J Obstet Gynecol MFM, 2025.PMID 39557196
16. [16]Bruno AM, Allshouse AA, Campbell HM, et al. Weight-Based Compared With Fixed-Dose Enoxaparin Prophylaxis After Cesarean Delivery: A Randomized Controlled Trial Obstet Gynecol, 2022.PMID 36075079
17. [17]Wei G, Harley F, O'Callaghan M, et al. Systematic review of urological injury during caesarean section and hysterectomy Int Urogynecol J, 2023.PMID 36251061
18. [18]Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries Obstet Gynecol, 2006.PMID 16738145
19. [19]Sotiriadis A, McGoldrick E, Makrydimas G, et al. Antenatal corticosteroids prior to planned caesarean at term for improving neonatal outcomes Cochrane Database Syst Rev, 2021.PMID 34935127
20. [20]Hannah ME, Hannah WJ, Hewson SA, et al. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group Lancet, 2000.PMID 11052579
21. [21]Phung LC, Farrington EK, Connolly M, et al. Intravenous oxytocin dosing regimens for postpartum hemorrhage prevention following cesarean delivery: a systematic review and meta-analysis Am J Obstet Gynecol, 2021.PMID 33957113