CPC on Caesarean Section Epidemic: Are We Creating More Harm Than Good?
Introduction
Caesarean section (CS) is a life-saving obstetric procedure when medically indicated; however, its use has increased alarmingly over the past few decades. Globally, CS rates have more than tripled, with several centres reporting rates exceeding 40–50%, largely driven by non-indicated or elective caesarean deliveries. Although CS is often perceived as a safer or more convenient option, growing evidence suggests that unnecessary primary caesarean sections are associated with significant short- and long-term maternal and neonatal morbidity.
This CPC highlights the hidden consequences of non-indicated primary caesarean sections, illustrated through a clinical case that progressed to placenta accreta spectrum (PAS) and emergency obstetric hysterectomy, emphasizing the need for judicious decision-making and preventive strategies.
Key Points
Rising Caesarean Section Rates
Significant global and national rise in CS rates, particularly non-indicated primary CS.
Many procedures performed for poorly documented or misinterpreted indications such as “fetal distress.”
Clinical Case Summary
A young multiparous woman with a prior non-indicated CS presented in a subsequent pregnancy with placenta previa and suspected PAS.
Advanced imaging confirmed placenta increta with focal percreta, necessitating planned multidisciplinary CS and hysterectomy.
The case demonstrates the long-term impact of an unnecessary first caesarean section.
Placenta Accreta Spectrum (PAS)
Prior CS is the strongest risk factor for PAS.
Risk increases exponentially with each additional CS.
PAS is a major cause of massive obstetric hemorrhage and peripartum hysterectomy.
Maternal Complications of Caesarean Section
Increased risk of:
Major hemorrhage and blood transfusion
Postoperative infection and sepsis
Venous thromboembolism
Operative injuries (bladder, bowel, ureter)
Emergency peripartum hysterectomy
Maternal mortality
Neonatal Complications
Higher rates of respiratory morbidity, especially in elective CS before 39 weeks.
Increased NICU admissions and transient tachypnea of the newborn.
Impact on Future Fertility and Pregnancies
Increased risk of infertility, placenta previa, PAS, uterine rupture, ectopic pregnancy, and preterm birth.
Repeat CS increases surgical difficulty due to adhesions.
Preventive Strategies
Mandatory senior review before primary CS.
Proper CTG interpretation training and documentation.
Strict use of partogram and regular labour ward audits.
Improved access to labour analgesia and midwife-led care.
Strengthening VBAC services and antenatal counselling.
