Casarean section

Question 1

What are the types of cesarean sections?

Answer 1

Classical or upper cesarean section.

Low cesarean section.

Question 2

What is the rate of cesarean sections (in percent) in Norway?

Answer 2

15-16 %.

Question 3

What are common maternal indications to perform a c-section?

Answer 3

Previous cesarean section
Failure to progress
Antepartum haemorrhage
Prevention of vertical transmission
Contracted pelvis/CPD

Question 4

What are common fetal indications to perform a c-section?

Answer 4

Fetal Distress.
Malpresentation/malposition.
Fetal abnormality.
Multiple pregnancy – Monochorionic twin.

Question 5

What are possible intraoperative complications when performing a c-section?

Answer 5

Difficult abdominal entry
Difficult delivery of the baby
Hemorrhage
Injury: to urinary tract, bowel, fetus, etc.
Anesthetic complications.

Question 6

What are possible early postoperative complications following a c-section?

Answer 6

Reactionary hemorrhage
Urinary retention
Paralytic ileus
DIC
Thromboembolism
Pelvic Infection
Wound complications such as hematomas or infection.

Question 7

What are possible late postoperative complications following a c-section?

Answer 7

Rupture of uterus.
Need for repeat c-section.
Intra-abdominal and intrauterine adhesions
Incisional hernia
Fistulae
Psychological
Medicolegal issues

Question 8

How are the maternal risks of morbidity and mortality for delivery through c-section compared to vaginal birth?

Answer 8

There is increased risk of maternal mortality and
severe acute morbidity, and a higher risk for adverse outcomes in subsequent pregnancy compared with vaginal birth.

Multiple c-sections are associated with a higher risk of maternal morbidity and mortality.

Question 9

What are benefits or c-section delivery?

Answer 9

Maternal benefits: Less frequent incontinence and urogenital prolapse.
Fetal benefits: Safer for the fetus. Less risk of hypoxic-ischemic encephalopathy (HIE).

Question 10

What are ways of preventing the “popularity” of having a c-section?

Answer 10

The delivery fees for physicians for undertaking c-sections and attending vaginal delivery should be the same.
Hospitals should be obliged to publish annual c-section rates, and financing of hospitals should be partly based on c-section rates.
Hospitals should use a uniform classification system for c-sections (Robson/WHO classification).
Women should be informed properly on the benefits and risks of a c-section.
Money that will become available from lowering c-section costs should be invested in resources, training and reintroduction of vaginal instrumental deliveries to
reduce the need for c-section in the second stage of labor.
In rural areas, adequate access to skilled care, to appropriate fetal surveillance, and to assisted births or operative delivery is essential.