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caesarian section

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In spite of the name, Julius Caesar was not delivered by this operation. The term caesarian section originated from Roman Law (or Lex Caesarea) where the fetus had to be removed from the body of a dead woman before she could be buried.

The "classical" operation involves a longitudinal, midline laparotomy with incision of the uterine fundus.

Frank in 1906 devised the lower segment caesarian section (LSCS). The procedure involves a "bikini line" transverse abdominal incision into the lower segment of the uterus.

During the 10 years since the National Caesarean Section Sentinel Audit was undertaken (2000-2001), many of the findings may have changed significantly

  • audit examined who was having a CS and why, as well as the views of women having babies and the obstetricians looking after them. The audit found that a 20% CS rate was considered too high by 51% of obstetricians. UK CS rates now average about 25% (1)

Length of hospital stay is likely to be longer after a CS (an average of 3-4 days) than after a vaginal birth (average 1-2 days)

  • however, women who are recovering well, are apyrexial and do not have complications following CS should be offered early discharge (after 24 hours) from hospital and follow-up at home, because this is not associated with more infant or maternal readmissions (1)

Maternal Mortality:

  • data from the Netherlands suggests (2)
    • risk of death after cesarean section was 21.9 per 100.000 cesarean sections (86/393,443) versus 3.8 deaths per 100.000 vaginal births (88/2,291,503): Relative Risk (RR) 5.7 (95% Confidence Interval [CI] 4.2-7.7)
    • compared to vaginal birth, maternal mortality after cesarean section was three times higher following exclusion of deaths that had no association with surgery. In approximately one in ten deaths after cesarean section, surgery did in fact initiate the chain of morbid events

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