Caesarean section: a journey not always smooth: complications of caesarean section

Mukesh Kumar; Rohini Sharma; Ravi Shah; Bharti Abhishake

doi:10.18203/2320-1770.ijrcog20260929

Authors

Mukesh Kumar Department of Obstetrics and Gynaecology, AIIMS Rishikesh, Uttarakhand, India https://orcid.org/0009-0001-0930-4612
Rohini Sharma Department of Obstetrics and Gynaecology, AIIMS Rishikesh, Uttarakhand, India
Ravi Shah Department of Obstetrics and Gynaecology, AIIMS Rishikesh, Uttarakhand, India
Bharti Abhishake Department of Radiodiagnosis, GMC Srinagar, Jammu and Kashmir, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20260929

Keywords:

Caesarean section, Obstetric haemorrhage, Placenta previa, Uterine rupture, Bladder injury, Maternal mortality, Uterine arteriovenous malformation

Abstract

Caesarean section (CS) is one of the most commonly performed obstetric procedures worldwide, with rates rising significantly over the past decades. While lifesaving, CS is associated with a spectrum of maternal and neonatal complications. Maternal risks include hemorrhage, uterocervical lacerations, urinary tract injury, postpartum infections, venous thromboembolism (VTE), chronic pelvic pain, uterine rupture, placenta previa, placenta accreta spectrum, caesarean scar ectopic pregnancy, caesarean scar niche, endometriosis, secondary infertility, and acquired uterine arteriovenous malformations (AVMs). Neonatal complications include superficial injuries, cephalhematoma, fractures, nerve injuries, lower Apgar scores, respiratory distress, increased NICU admissions, and long-term risks of asthma, obesity, and immune-related disorders. The increasing prevalence of CS underscores the importance of understanding its short-and long-term impacts on maternal and child health, emphasizing the need for careful risk assessment, preventive strategies, and informed clinical management.

Author Biography

Mukesh Kumar, Department of Obstetrics and Gynaecology, AIIMS Rishikesh, Uttarakhand, India

I, Dr. Mukesh Kumar, a specialist in Obstetrics and Gynaecology, trained at the All India Institute of Medical Sciences (AIIMS), Rishikesh. My clinical and academic interests include maternal–fetal medicine, high-risk pregnancy, minimally invasive gynecologic surgery, and evidence-based obstetric practice. I am committed to advancing women’s health through clinical excellence, research, and continuous medical education.

References

Boley JP. The History of Cæsarean Section. Can Med Assoc J. 1935;32(5):557-9.

Hem E, Børdahl PE. Max Sänger-Father of the Modern Caesarean Section. Gynecol Obstet Invest. 2003;55(3):127-9. DOI: https://doi.org/10.1159/000071524

Uterine Incision Techniques | IntechOpen. Avaible at: https://www.intechopen.com/chapters/89525. Accessed on 27 December 2025.

Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and Projections of Caesarean Section Rates: Global and Regional Estimates. BMJ Glob Health. 2021;6(6):e005671. DOI: https://doi.org/10.1136/bmjgh-2021-005671

Pandey AK, Raushan MR, Gautam D, Neogi SB. Alarming Trends of Cesarean Section-Time to Rethink: Evidence from a Large-Scale Cross-Sectional Sample Survey in India. J Med Internet Res. 2023;25(1):e41892. DOI: https://doi.org/10.2196/41892

Wormer KC, Jamil RT, Bryant SB. Postpartum Hemorrhage. In StatPearls; StatPearls Publishing: Treasure Island (FL). 2025.

Sajjad H, Shakeel N, Kanwal S, Sabir S, Nadeem S, Arshad H. Incidence and Risk Factors of Postpartum Hemorrhage in Cesarean Versus Vaginal Deliveries: A Retrospective Study. Cureus. 2025;17(10):e95714. DOI: https://doi.org/10.7759/cureus.95714

Wong LF, Wilkes J, Korgenski K, Varner MW, Manuck TA. Intrapartum Cervical Laceration and Subsequent Pregnancy Outcomes. AJP Rep. 2016;6(3):e318-23. DOI: https://doi.org/10.1055/s-0036-1592198

Safrai M, Stern S, Gofrit ON, Hidas G, Kabiri D. Urinary Tract Injuries during Cesarean Delivery: Long-Term Outcome and Management. J Matern Fetal Neonatal Med. 2022;35(18):3547-54. DOI: https://doi.org/10.1080/14767058.2020.1828336

Boushra M, Carlson K, Rahman O. Postpartum Infection. In StatPearls; StatPearls Publishing. 2025.

Blondon M, Casini A, Hoppe KK, Boehlen F, Righini M, Smith NL. Risks of Venous Thromboembolism After Cesarean Sections: A Meta-Analysis. Chest. 2016;150(3):572-96. DOI: https://doi.org/10.1016/j.chest.2016.05.021

Riches J, Chimwaza Y, Chakhame BIM, Milln J, Twabi HH, Bilesi R, et al. Maternal Mortality Following Caesarean Section in a Low-Resource Setting: A National Malawian Surveillance Study. BMJ Glob Health 2024;9(11):e016999. DOI: https://doi.org/10.1136/bmjgh-2024-016999

Li L, Wan W, Zhu C. Breastfeeding after a Cesarean Section: A Literature Review. Midwifery. 2021;103:103117. DOI: https://doi.org/10.1016/j.midw.2021.103117

Dodampahala SH, Chandrasena L, Abeysuriya V. Incisional herniae following lower segment caesarean section: A 20-year chart review. Sri Lanka J Obstet Gynaecol. 2023;45(2):80-3. DOI: https://doi.org/10.4038/sljog.v45i2.8078

Nogueira AA, Silva JCR, Neto OBP. The Potential of Cesarean Section as a Causative Factor of Chronic Pelvic Pain. Rev. Bras. Ginecol. E Obstetrícia RBGO Gynecol Obstet. 2016;38(2):53-5. DOI: https://doi.org/10.1055/s-0036-1571850

Savukyne E, Bykovaite-Stankeviciene R, Machtejeviene E, Nadisauskiene R, Maciuleviciene R, Savukyne E, et al. Symptomatic Uterine Rupture: A Fifteen Year Review. Medicina (Mex.) 2020;56(11):574. DOI: https://doi.org/10.3390/medicina56110574

Jauniaux E, Jurkovic D. Placenta Accreta: Pathogenesis of a 20th Century Iatrogenic Uterine Disease. Placenta. 2012;33(4):244-51. DOI: https://doi.org/10.1016/j.placenta.2011.11.010

Kayem G, Seco A, Vendittelli F, Crenn Hebert C, Dupont C, Branger B, et al. Risk Factors for Placenta Accreta Spectrum Disorders in Women with Any Prior Cesarean and a Placenta Previa or Low Lying: A Prospective Population-Based Study. Sci Rep. 2024;14(1):6564. DOI: https://doi.org/10.1038/s41598-024-56964-9

Lin R, DiCenzo N, Rosen T. Cesarean Scar Ectopic Pregnancy: Nuances in Diagnosis and Treatment. Fertil Steril. 2023;120(3, Part 2):563-72. DOI: https://doi.org/10.1016/j.fertnstert.2023.07.018

Miller R, Gyamfi-Bannerman C. Society for Maternal-Fetal Medicine Consult Series #63: Cesarean Scar Ectopic Pregnancy. Am J Obstet Gynecol. 2022;227(3):B9-20. DOI: https://doi.org/10.1016/j.ajog.2022.06.024

Arkoudis NA, Moschovaki-Zeiger O, Prountzos S, Spiliopoulos S, Kelekis N. Caesarean-Section Scar Endometriosis (CSSE): Clinical and Imaging Fundamentals of an Underestimated Entity. Clin Radiol. 2023;78(9):644-54. DOI: https://doi.org/10.1016/j.crad.2023.05.020

Armstrong F, Mulligan K, Dermott RM, Bartels HC, Carroll S, Robson M, et al. Cesarean Scar Niche: An Evolving Concern in Clinical Practice. Int J Gynecol Obstet. 2023;161(2):356-66. DOI: https://doi.org/10.1002/ijgo.14509

Hinterleitner L, Kiss H. The Impact of Cesarean Section on Female Fertility: A Narrative Review. Clin Exp Obstet Gynecol. 2021;48(4):781-6. DOI: https://doi.org/10.31083/j.ceog4804125

García-Mejido JA, García-Jiménez R, Rodriguez-Cruz L, Neguillo-Moguel R, Borrero C, Sainz-Bueno JA, et al. Ultrasound Diagnosis of Uterine Arteriovenous Malformations: A Systematic Review. Clin Exp Obstet Gynecol. 2023;50(8):167. DOI: https://doi.org/10.31083/j.ceog5008167

Kulas T, Bursac D, Zegarac Z, Planinic-Rados G, Hrgovic Z. New Views on Cesarean Section, Its Possible Complications and Long-Term Consequences for Children’s Health. Med Arch. 2013;67(6):460-3. DOI: https://doi.org/10.5455/medarh.2013.67.460-463

Indraccolo U, Pace M, Corona G, Bonito M, Indraccolo SR, Di Iorio R. Cesarean Section in the Absence of Labor and Risk of Respiratory Complications in Newborns: A Case-Control Study. J Matern Fetal Neonatal Med. 2019;32(7):1160-6. DOI: https://doi.org/10.1080/14767058.2017.1401999

Słabuszewska-Jóźwiak A, Szymański JK, Ciebiera M, Sarecka-Hujar B, Jakiel G, Słabuszewska-Jóźwiak A, et al. Pediatrics Consequences of Caesarean Section-A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2020;17(21):8031. DOI: https://doi.org/10.3390/ijerph17218031

Khasawneh W, Obeidat N, Yusef D, Alsulaiman JW. The Impact of Cesarean Section on Neonatal Outcomes at a University-Based Tertiary Hospital in Jordan. BMC Pregnancy Childbirth. 2020;20(1):335. DOI: https://doi.org/10.1186/s12884-020-03027-2

Sevelsted A, Stokholm J, Bønnelykke K, Bisgaard H. Cesarean Section and Chronic Immune Disorders. Pediatrics. 2015;135(1):e92-8. DOI: https://doi.org/10.1542/peds.2014-0596