Anatomy and Physiology of Female For Cesarean Section

I.
Anatomy and Physiology of Female for Cesarean Section
The uterus or womb is a pear-shaped organ that is found in the pelvis at the top of the vagina.
The uterus in a woman that is not pregnant does not extend above the pubic bone.
 In the pregnant woman at the end of pregnancy, the uterus enlarges to approximately 40
centimeters (16 inches) above the pubic bone
 The cervix is found at the lowermost portion of the uterus and is the opening through
which the fetus passes during delivery. Normally, this opening is closed until late in the
pregnancy
 Fertilization occurs within the fallopian tubes. The fallopian tubes are found at the top of
the uterus, one on each side. The end of each fallopian tube has fingerlike projections
called fimbria which guide the egg from the ovary into the Fallopian tube
 The fertilized egg then passes from the Fallopian tube into the cavity within the uterus
where the fertilized egg implants into the wall of the uterus. The site of implantation
becomes the
 As the egg develops into a fetus the remains attached to the fetus through the umbilical
cord. Thus, the blood supply to the fetus originates in the uterine wall
 The umbilical cord extends from the to the fetus where it inserts at umbilicus (belly
button) of the fetus
Cesarean section (C-section) - is the delivery of a newborn through a surgical incision in the
abdomen and front (anterior) wall of the uterus. The C-section rate may approximate 30% in
some hospitals, particularly where high-risk pregnancies are managed. This rate of C-section is
usually less for women with uncomplicated pregnancies.
Classification of Cesarean Delivery
Caesarean sections can be classified as either “elective” (planned) or “emergency”
1. Emergency Caesarean sections can then be subclassified into three categories, based on
their urgency. This is to ensure that babies are delivered in a timely manner in accordance
to their or their mother’s needs. Emergency Caesarean sections are most commonly for
failure to progress in labor or suspected/confirmed fetal compromise.
2. Planned or ‘elective’ Caesarean section is performed for a variety of indications. The

following are the most common, but this is not an exhaustive list:
 Breech presentation (at term) – planned Caesarean sections for breech presentation at

term have increased significantly since the ‘Term Breech Trial’ [Lancet, 2000].
 Other malpresentations – e.g. unstable lie (a presentation that fluctuates from oblique,
cephalic, transverse etc.), transverse lie or oblique lie.
 Twin pregnancy – when the first twin is not a cephalic presentation.
 Maternal medical conditions (e.g. cardiomyopathy) – where labor would be dangerous

for the mother.
 Fetal compromise (such as early onset growth restriction and/or abnormal fetal

Dopplers) – where it is thought the fetus would not cope with labor.
 Transmissible disease (e.g. poorly controlled HIV).
 Primary genital herpes (herpes simplex virus) in the third trimester – as there has been
no time for the development and transmission of maternal antibodies to HSV to cross the
placenta and protect the baby.
 Placenta previa – ‘Low-lying placenta’ where the placenta covers, or reaches the
internal os of the cervix.
 Maternal diabetes with a baby estimated to have a fetal weight >4.5 kg.
 Previous major shoulder dystocia.
 Previous 3rd/4th perineal tear where the patient is symptomatic – after discussion with

the patient and appropriate assessment.
 Maternal request – this covers a variety of reasons from previous traumatic birth to
‘maternal choice’. This decision is after a multidisciplinary approach including
counselling by a specialist midwife.
Complication in Cesarean Section
A. Risks and Complications for the Mom
 Infection: Infection can occur at the incision site, in the uterus and in other pelvic organs
such as the bladder.
 Hemorrhage or increased blood loss: There is more blood loss in a cesarean delivery
than with a vaginal delivery. This can lead to anemia or a blood transfusion (1 to 6
women per 100 require a blood transfusion).
 Injury to organs: Possible injury to organs such as the bowel or bladder (2 per 1002).
 High or Persistent Fever: A high or persistent fever is often the first sign of an infection
(most commonly a bacterial infection at the incision site). Certain women may be at
higher risk of infection than others. These include women who are obese, have diabetes,
or take long-term steroid medications.
 Adhesions: Scar tissue may form inside the pelvic region causing blockage and pain.
Adhesions can also lead to future pregnancy complications such as placenta previa or
placental abruption.
 Worsening or Persistent Pain: Pain and surgery go hand in hand but can usually be
treated with the appropriate painkiller. Severe pain, by contrast, is never considered
normal. This not only includes abdominal or pelvic pain but postpartum cramps that fail
to get better after the third or fourth day.
 Extended recovery time: The amount of time needed for recovery after a cesarean can
range from weeks to months. Extended recovery can have an impact on bonding time
with your baby (1 in 14 reports incisional pain six months or more after surgery)
 Breathing Difficulty: After surgery, it is not uncommon to feel a little discomfort when
inhaling or exhaling. However, breathing problems that persist or worsen is never a good
thing. This sort of problem can sometimes occur in women who had been given general
anesthesia as part of the cesarean procedure. Anesthesia is known to hamper normal
breathing and can often lead to the buildup of mucus in the lungs.
 Reactions to medications: There can be a negative reaction to the anesthesia given

during a cesarean or negative reaction to pain medication given after the procedure.
 Risk of additional surgeries: Includes possible hysterectomy, bladder repair or another

cesarean.
 Emotional reactions: Some women who have had a cesarean report feeling negative
about their birth experience and may have trouble with initial bonding with their baby.
B. Risks and Complications for the Baby
 Premature birth: If gestational age was not calculated correctly, a baby delivered by
cesarean could be delivered too early and have low birth weight.
 Breathing problems: When delivered by cesarean, a baby is more likely to have

breathing and respiratory problems. Some studies show the existence of a greater need for
assistance with breathing and immediate care after a cesarean than with a vaginal
delivery.
 Low APGAR scores: Low APGAR scores can be the result of anesthesia, fetal distress
before the delivery or lack of stimulation during delivery (Vaginal birth provides natural
stimulation to the baby while in the birth canal). Babies born by cesarean are 50% more
likely to have lower APGAR scores than those born vaginally)
 Fetal injury: Very rarely, the baby may be nicked or cut during the incision (on average,
1 or 2 babies per 100 will be cut during the surgery).
References:
Clapp MA, Barth WH. 2017 Dec;60(4):829-839. The Future of Cesarean Delivery

Rates in the United States. Clin Obstet Gynecol. [PubMed]
Teach Me ObGyn, Part of the Teach Me Series (2020). Caesarean Section. Retrieved
from https://teachmeobgyn.com/labour/delivery/caesarean-section/
Robin Elise Weiss, PhD, MPH (July, 2019). When to call your Doctor after a
Cesarean Section.
WebMD LLC. (February, 2020). Complications of Cesarean Deliveries. Retrieved

from https://www.medscape.org/viewarticle/512946_4
Hedwige Saint Louis, MD, MPH, FACOG, Christine Isaacs, MD. (December 14,
2018). Cesarean Delivery.

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I.

Anatomy and Physiology of Female for Cesarean Section

Caesarean sections can be classified as either “elective” (planned) or “emergency”

2. Planned or ‘elective’ Caesarean section is performed for a variety of indications. The

 Breech presentation (at term) – planned Caesarean sections for breech presentation at

 Maternal medical conditions (e.g. cardiomyopathy) – where labor would be dangerous

 Fetal compromise (such as early onset growth restriction and/or abnormal fetal

 Maternal diabetes with a baby estimated to have a fetal weight >4.5 kg.

 Previous major shoulder dystocia.

 Previous 3rd/4th perineal tear where the patient is symptomatic – after discussion with

A. Risks and Complications for the Mom

 Reactions to medications: There can be a negative reaction to the anesthesia given

 Risk of additional surgeries: Includes possible hysterectomy, bladder repair or another

B. Risks and Complications for the Baby

 Breathing problems: When delivered by cesarean, a baby is more likely to have

Clapp MA, Barth WH. 2017 Dec;60(4):829-839. The Future of Cesarean Delivery

WebMD LLC. (February, 2020). Complications of Cesarean Deliveries. Retrieved

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