Nieto‐Calvache, Albaro Jose;
Ramasauskaite, Diana;
Palacios‐Jaraquemada, Jose Miguel;
Hussein, Ahmed M;
Jauniaux, Eric;
Ubom, Akaninyene Eseme Bernard;
Rivera‐Torres, Luisa F;
... Wright, Alison; + view all
(2025)
Complex cesarean section: Surgical approach to reduce the risks of intraoperative complications and postpartum hemorrhage.
International Journal of Gynecology & Obstetrics
10.1002/ijgo.16094.
(In press).
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Abstract
The incidence of cesarean section is dramatically increasing worldwide, whereas the training opportunities for obstetrician/gynecologists to manage complex cesarean section appear to be decreasing. This may be attributed to changing working hours directives and the increasing use of laparoscopy for gynecological surgical procedures, including in gynecological oncology. Various situations can create surgical difficulties during a cesarean section; however, two of the most frequent are complications from previous cesarean (myometrial defects, with or without placental intrusion and peritoneal adhesions) and the high risk of postpartum hemorrhage (uterine overdistension, abnormal placentation, uterine fibroids). Careful surgical dissection, with safe mobilization of the bladder and exposure of the anterior and lateral surfaces of the uterus, are pivotal steps for resolving the technical difficulties inherent in performing a complex cesarean section. We propose a standardized surgical protocol for women at risk of complex cesarean, including the antenatal identification of increased surgical risk, paramedian access to the pelvis, bladder dissection and mobilization, and the selection of a bleeding control strategy, considering uterine anatomy and the arterial pedicles involved in blood loss, which should be tailored to the individual case. We propose preoperative surgical planning to include consideration of the most common situations encountered during a complex cesarean, which facilitates anticipating an appropriate response for common possible scenarios, and can be adapted for low‐, middle‐, and high‐resource settings. This protocol also highlights the importance of self‐evaluation, continuous learning, and improvement activities within surgical teams.
| Type: | Article |
|---|---|
| Title: | Complex cesarean section: Surgical approach to reduce the risks of intraoperative complications and postpartum hemorrhage |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1002/ijgo.16094 |
| Publisher version: | https://doi.org/10.1002/ijgo.16094 |
| Language: | English |
| Additional information: | © 2025 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
| Keywords: | complex cesarean section compressive uterine sutures postpartum hemorrhage protocolized treatment surgical technique |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health > Reproductive Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10203033 |
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