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p Bicornuate uterus: this usually would lead to abnorma presentation or lie of baby and also poor progress of labor p One of the rarest causes for a CS is when resuscitation is being performed or in the unfortunate case when the mother dies and a Caesar is done to save the baby’s life. Risks of Caeserean Sections Some people believe that a Caeserean Section is a panacea. Don’t get me wrong I strongly believe with a good indication a CS should be performed promptly when indicated, but everyone should understand that it is not without risks. Some of our colleagues may argue that a vaginal delivery also has risks and I concur but the role of an obstetrician is to weigh the risks of an individual client or patient and come up with a decision that would have a better prognosis fo r both the baby and mother. It is not always black and white and it is not as easy as it sounds and is usually the cause of a lot of litigation making the profession less attractive in certain countries but that can be a discussion for another day. So what risks are associated with Caeserean Sections? Several risks are associated with having a CS that include: p Heavy bleeding: Generally it is accepted that blood loss during a CS is higher than that during a normal delivery. There are various techniques to minimize the amount of blood lost but in some instances especially previous scars with bad scar tissue or dhesions, when the uterus does not contract after delivery, patients with bleeding disorders and so on bleeding can be severe enough and can in unfortunate cases even abdominal or pelvic surgeries. lead to death. This is especially so in peripheral facilities where access to p Endometriosis (cells from the blood and drugs can be a challenge. uterine lining that grow outside the womb) causing pain. p Infection: Wound infection is quite p Negative psychological common after any form of surgery consequences with unplanned and a CS is no exception and due caesarean. to other factors such as anaemia infections can also be severe p Death enough to lead to sepsis which is very difficult to cure once it sets in. Our baby is not spared also and risks to the baby include: p Internal organs such as the urinary bladder and intestines are at risk of p Accidental surgical cuts to getting accidental cuts during presenting part, sometimes severe surgery and this is more so in enough to require suturing. patients who have had previous surgery. p Being born pre-term (34-36 weeks of pregnancy) as a result of p Patients undergoing a CS are more scheduled surgery. like to have their uteruses removed because of uncontrollable bleeding p Complications of prematurity that however even someone having a include difficulties with breathing, normal delivery can undergo the digestion, liver function, jaundice, same. dehydration, infection feeding and regulating blood sugar levels and p Complications from anaesthesia body temperature and some presuch as postdural puncture spinal term babies may experience headaches, drug allergies, difficult learning or behavior problems in intubation and so on. school due to immature brains at birth. p Development of deep venous clots that can travel to the lungs p Readmission to hospital. (pulmonary embolism) and brain (stroke). p Problems with breastfeeding leading to childhood development p Complications leading to of asthma, sensitivity to allergens admission to an intensive care unit. or type 1 diabetes. p Readmission to hospital for p Death in the first 28 days of life. complications related to the surgery e.g. wound sepsis, incisional It is my trust that the pros and cons hernias. of Caeserean Sections are well rested with you after navigating through p Long standing pain: more women this piece. We shall continue on the report problems with pain from the journey to enlighten you more on this caesarean incision than report pain and related matters via this column. in the genital area after vaginal birth. Dr. Maureen Owiti is a Gynaecologist based in Nairobi. You can commune with p Adhesions, thick internal scar her on this or related matters via mail at: tissue that may cause future chronic [email protected]. pain and in rare cases a twisted bowel and can complicate future