caesarian section

Last edited 09/2023 and last reviewed 10/2023

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.

Timing of planned caesarean birth (1)

• do not routinely carry out planned caesarean birth before 39 weeks, as this can increase the risk of respiratory morbidity in babies

Incision in caesarian birth (1)

• pefrform caesarean birth using a low, transverse, straight skin incision with subsequent tissue layers opened bluntly and, if necessary, extended using sharp dissection
  • this may need to be modified with a higher incision for women and pregnant people with class 3 obesity (BMI 40 kg/m2 or more)
  • a vertical midline incision may be required for some clinical indications

Classification of urgency for caesarean birth (1)

• Category 1. Immediate threat to the life of the woman or fetus (for example, suspected uterine rupture, major placental abruption, cord prolapse, fetal hypoxia or persistent fetal bradycardia)
• Category 2. Maternal or fetal compromise which is not immediately life-threatening
• Category 3. No maternal or fetal compromise but needs early birth
• Category 4. Birth timed to suit woman or healthcare provider

Caesarean sections rates have continued to increase in the UK since 2014, with 2019/20 data showing 34.5% of deliveries by caesarean section in Scotland (up 5.2% from 2014) and 2019/20 data showing rates of 31% in England (up 4.7% from 2014) and 28% in Wales (up 1.7% from 2014) (2)

Maternal Mortality:

• data from the Netherlands suggests (3)
  • 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

NICE have produced this resource that quantifies the benefits and risks of planned caesarian section versus vaginal delivery

Reference:

• NICE (September 2023). Caesarian Section
• Scottish Government. The Best Start - caesarean section rates: review report (accessed 24th June 2023)
• Kallianidis AF et al. Maternal mortality after cesarean section in the Netherlands.Eur J Obstet Gynecol Reprod Biol. 2018 Oct;229:148-152