Cesarean Delivery and Surgical Sterilization

This chapter discusses the current practice of cesarean delivery, the indications for the operation, the performance of the surgery, and its potential complications. After forceps and vacuum extraction procedures, symphysiotomy is the principal alternative to the cesarean operation. Epidurals do prolong the second stage of labor and increase the use of oxytocin to maintain progress. As the morbidity associated with cesarean delivery remains low, and the risks associated with elective operations are better appreciated, indications for cesarean operations have progressively increased. The chapter reviews the operative technique for cesarean delivery, cesarean hysterectomy, and the surgical management of acute obstetric hemorrhage. Possible immediate post-operative complications of surgical sterilization include infection, bleeding, intraoperative bowel or bladder injury, thromboembolism, and rarely, death. Sterilization failures are often the result of either mistaken identification of some other intraabdominal structure for the fallopian tube, or of incomplete occlusion of the tubal lumina.