Short and Long-term Maternal and Neonatal Outcomes of Caesarean Section

Caesarean section is one of the most performed operations across the world. Caesarean birth (CB) rates are rising globally, which is in part due to the increasing medical complexity of women becoming pregnant, changes in national guidance allowing “maternal request” CB and increasing use to prevent fetal and maternal morbidity in labour. Although it is an operation that is performed regularly and in general on a surgical low-risk patient, it can be accompanied by significant risks, when compared to vaginal birth (VB), both in the short-term and the long-term, for both mother and neonate. In the short-term, there is a significant risk of bleeding, postoperative infection and fetal injury. There is also rarer, more significant risks of visceral injury, admission to intensive care, venous thromboembolism, return to theatre and peripartum hysterectomy. CB has slightly higher rate of maternal death than VB. In the longer-term, previous CB can significantly complicate pregnancy and delivery, and serious risks include abnormal placentation and uterine rupture which can be accompanied by significant morbidity. CB has also been associated with lower live birth rate after IVF/ICSI and development of some childhood conditions. There is conflicting evidence of its effect on other conditions, such as subfertility and birth satisfaction. However, CB also has some benefits. It allows a woman to plan a delivery, reducing the risk of an unplanned event in labour. It reduces the risk of perineal and anal sphincter trauma and development of pelvic organ prolapse in later life. Decision for CB is an individual one, based on each woman’s perception of the above risks and benefits, but both the long- and short-term implications must be fully considered and are likely to become more widely discussed as more evidence emerges.