Key content
The incidence and presentation of complications of
caesarean section.
The surgical management of intrapartum and
postpartum haemorrhage.
Risk factors for, and prevention and treatment of
postpartum sepsis.
Presentation, investigation and repair of bladder injuries
when recognised intraoperatively and following
delayed presentation.
Risk factors for, and recognition and management of suspected
ureteric injury intraoperatively and postoperatively.
Bowel complications including intraoperative bowel
injury and management, postoperative ileus and
Ogilvie syndrome.
Particular risks and complications associated with caesarean
section at full dilatation.
Caesarean section in the developing world.
Learning objectives
To be aware of the most common and serious complications of
caesarean section.
To be able to describe recognition and initial surgical management
of suspected bladder, ureteric and bowel injuries.
To be familiar with delayed presentations of visceral injuries and
have a systematic approach to investigation of suspected injury.
To understand the impact of caesarean section complications in
resource-poor countries.
Ethical issues
Appropriate, accurate preoperative counselling regarding risks
and consent.
Awareness of personal competency in managing
specific complications.
Keywords: caesarean section / complications / haemorrhage / ileus /
Ogilvie syndrome / sepsis / visceral injury
Introduction
Haemorrhage
Postoperative sepsis
Ureteric injury
Bowel injury
Postoperative ileus
Ogilvie syndrome
Ogilvie syndrome is defined as acute large bowel obstruction
without a mechanical cause.36 It is not specific to caesarean
section but can occur in any patient undergoing surgery and,
indeed, has been reported in nonsurgical patients with
serious underlying medical conditions. The exact
pathophysiology is unknown but it may be due to an
imbalance in the autonomic innervation of the distal colon
leading to atony and subsequent proximal dilatation. During
a caesarean section, Ogilvie syndrome may be caused by
damage to the sacral parasympathetic nerve supply, which
runs close to the cervix, vagina and broad ligament.36 The
classic presentation is progressive abdominal distension,
which may initially be painless and associated with varying
degrees of constipation. As the caecum becomes more
dilated, the pain worsens, localising to the right-hand side
with associated tachycardia. Eventually there is caecal
ischaemia, perforation and peritonitis.
Caesarean section at full dilatation
Conclusion
Caesarean section is one of the most commonly performed
surgical procedures in the world. There are a variety of
complications that may be uncommon but potentially very
serious when they occur. Obstetricians must operate with a
meticulous surgical technique and retain a high index of
suspicion for complications, particularly visceral trauma, as
delayed recognition is associated with a significantly poorer
outcome. Most complications will be recognised at the time of operation and are easily corrected either by the operating surgeon or by seeking assistance from
other specialties.