16 - Unintended traumaand complicationsduring caesarean section

Summary

Unintended trauma and complications during caesarean section (CS) include: (i) difficult delivery of the fetus (ii) fetal injuries (iii) bleeding (iv) bladder and/or ureteric injuries (v) small or large bowel injuries. The main causes of bleeding are: tone, tissue, trauma, and thrombin. Care should be taken to avoid inadvertent injury to adjacent structures (ureters and bladder) and these extensions should be secured with haemostatic sutures. Inferior epigastric vessels are notorious for retraction and hence prompt recognition of injury and immediate repair is mandatory to avoid primary surgical haemorrhage and return to theatre. Care should be taken to clamp, cut and ligate omental vessels whilst performing adhesiolysis. It is good practice to always check for bladder injuries after closure of the uterine incision and before closing the peritoneal cavity. Obstetricians should be able to recognise organ damage and repair the injury in low-resource settings.