Cesarean Birth Can Sometimes Cause Rare Complications

One of my favorite TV shows, but whose first season should not be viewed prior to giving birth, is 2014-2015 Cinemax series The Knick. Set in New York City in the years 1900-1901, this was a period medical drama focusing especially on the formative years of modern surgery. The very first episode begins with a cesarean section, attempted on account of placenta previa (the placenta is blocking the cervix), making vaginal delivery potentially fatal. The woman and her baby did not survive, nor were the turn of the 20th century surgeons successful over the next couple of attempts during season 1, until finally they figured out how get through the procedure without a fatal amount of blood loss.

Today, in the 21st century, quite contrasted with the setting of The Knick, cesarean birth is routine and extremely safe. This is true, whether you undergo an emergency C-section for complications like preeclampsia or failure of labor to progress, or whether it’s a planned, elective C-section. You have no reason to worry. But like any operation, or for that matter like vaginal delivery, there always is the possibility of complications, so we’ll explore those in this post.

First, let’s discuss the anesthesia, since that’s vital to the procedure and there are potential complications from that. In almost all cases, you will receive neuraxial anesthesia, a type of regional anesthesia, meaning that anesthesiologist injects a local anesthetic to block certain nerves. This makes you insensitive to pain in a region of the body, while you remain awake. In the case of neuraxial anesthesia, the body region that is anesthetized is everything below a certain level of the torso. There are two types of neuraxial anesthesia: spinal anesthesia and epidural anesthesia. Both are administered through a needle between two vertebrae of the lower spine. To induce spinal anesthesia, the anesthesiologist passes the needle through the two outermost of the three meninges (layers of connective tissue that cover the spinal cord and the brain) and thus into the subarachnoid space, which holds the cerebrospinal fluid. To induce epidural anesthesia, the needle is not inserted as deep, but just deep enough to inject the anesthetic over the outermost meninx, the dura mater. That’s the meaning of the term epidural.

Potential complications of neuraxial anesthesia are rare, but they include a headache from loss of some cerebrospinal fluid, backache, and some temporary neurological symptoms. It’s also possible to get a hematoma, meaning that blood collects into a clump, usually around the site of the injection. It’s very rare, but possible for the procedure to convert to total spinal anesthesia, where the anesthetic moves up too high in the body. Other rare complications include meningitis (inflammation of the meninges), arachnoiditis (inflammation specifically of the arachnoid meninx), a drop in blood pressure, cardiac arrest, retention of urine, and toxicity of the local anesthetic agent. Just to emphasize the point again, the complications are rare and overall neuraxial anesthesia is considered safer than general anesthesia.

As for the cesarean procedure itself, as you may imagine, emergency C-sections have a higher rate of complications compared with planned C-sections. As with any surgical procedure, there is a long list of possible complications. They are rare and certain measures are taken to prevent them of make them less likely. One such preventive measure is to give the patient medication that blocks the release of stomach acid, antibiotics are given prior to the procedure to reduce the risk of infection, and oxytocin is given to reduce the risk of postpartum hemorrhage. Also, after the procedure, one everything is closed up and there is no bleeding, doctors give low molecular weight heparin to reduce the risk of venous thromboembolism.

During a cesarean section, there also is a risk of what doctors call aspiration pneumonitis. This is caused by reflux of acidic contents from the stomach and aspiration of the stomach contents, because of long periods lying flat. Medications to stop the stomach from secreting acid are given to reduce stomach acid, and consequently aspiration pneumonitis. As with any surgical procedure, bleeding, pain, and infection are high on the list of possible complications. There also are various complications that can occur with the wound after the operation, plus there is a risk of endometritis and damage to local structures, such as the ureters, bladder, blood vessels, and bowel. Problems with the bowel include ileus, which is a temporary lack of normal contractions of the intestines. Additionally, there is a possibility of adhesions, meaning that scar tissue grows, potentially disrupting organs. Cesarean also increases the risk of future need for cesarean, uterine rupture, placenta previa, and stillbirth.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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