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What are the potential complications of the caesarean section itself?
It is important to keep things in perspective. The safety of caesarean section has improved dramatically over the years. However, it remains a major operation, with the potential for serious complications.
This means, when necessary, the doctor will not hesitate to do it. By the same token, when it is not really indicated, the doctor should resist the temptation to do it. Studies show that for major childbirth complications including serious infection, severe haemorrhage and even cardiac arrest, caesarean section is roughly three times riskier. A good enough reason, if one was needed, for a pause for thought.
Apart from complications which are attributable to the anaesthesia as described above, other things which may happen include:
Haemorrhage: this can be so severe that it requires multiple transfusions. In extreme cases - which occur from time to time - the bleeding may be such that a hysterectomy has to be done as a life-saving measure.
Injury to adjacent structures: during a difficult operation, structures such as loops of bowel and the urinary tract (bladder and ureters) may be injured. Normally, if recognized, injuries can be repaired relatively easily. If, however, they go unrecognized, they can lead to serious complications requiring a repeat operation and a long recovery period.
Infection: infection of the lining of the womb (endometritis) may follow a caesarean section. This has the potential for serious consequences, as eventual healing may produce a weak scar which may not withstand a subsequent pregnancy or labour. Again, this is uncommon. Infection is sometimes confined to the abdominal wound but this also means a prolonged and uncomfortable recovery period. The resulting scar may also be unsightly. Preventative (prophylactic) antibiotics are nowadays given to almost all mothers before or during a caesarean section to reduce the possibility of infection afterwards.
Pulmonary embolism: This is an uncommon condition where a clot or clots form within the veins and may be dislodged, travel and end up in vessels within the lungs, with sometimes very serious consequences. Since pregnancy is in itself a condition that promotes blood clotting, a major operation during pregnancy increases the risk of thrombosis and even pulmonary embolism..
Respiratory problems: Lung collapse (atelectasis) with pain and breathing difficulties may follow any major surgery, including caesarean section. Pneumonia may also occur.
Bowel problems: Intestinal ileus, where a loop of bowel is filled with gas, causing very uncomfortable abdominal distension, sometimes occurs and may last up to two days or so. Constipation is another minor potential complication.