Complex Cesarean Section

*Salvatore Felis, Marta Fiamberti and Chiara Peluffo*

### **Abstract**

The cesarean section, in principle, is not a complex surgical procedure when compared to many others performed in our specialty. However, there is a complex set of physiological and anatomical elements and circumstances that must interact perfectly to obtain an optimal result. Surgical technique is a factor but is often not the primary determinant of a positive outcome; concomitant circumstances interact in a cesarean section such as obstructed labor, abruptio placenta, morbid invasion of the placenta, previous pelvic infection, chorioamnionitis/endometritis, chronic and acute anemia, inadequate blood or insufficient transfusion capacity, oxytocics, anesthetics, lack of (or lack of appropriate administration of) antibiotics, and trained or motivated personnel. In all these cases, and in many other contexts, less-than-optimal results may occur, even in the face of a perfect surgical technique.

**Keywords:** complex cesarean section, adequate resources, inadequate resources, hemorrhage, hysterectomy

### **1. Introduction**

The cesarean section is ideally not a complex surgical procedure compared to many others performed in our specialty. However, a complex set of elements and physiological and anatomical circumstances should/must interact perfectly to obtain a good result. Surgical technique is often not the primary determinant of a positive outcome; the outcome comprehends the interaction of many factors such as obstructed labor, abruptio placenta, placenta previa, previous pelvic infection, chorioamnionitis/endometritis, chronic or acute anemia, insufficient transfusion capacity, oxytocic, anesthetics, absence of antibiotic therapy or wrong choice of antibiotics, and trained or motivated staff. In all these situations and in many other contexts, far from optimal results may occur despite a perfect surgical technique. As the number of cesarean sections in the world is growing, challenging interventions will become the standard rather than the exception. It is mandatory that obstetricians should receive initial and ongoing training focused on recognizing conditions of increased risk and those who are entrusted with the surgery have adequate experience in managing multiple complications frequently associated with a cesarean section. This may involve a revision of the procedures and the development of guidelines appropriate for the referral of cases with the highest risk of complications at these centers of excellence.
