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Unintended trauma and complications during caesarean section (CS) include: (i) difficult delivery of the fetus (ii) fetal injuries (iii) bleeding (iv) bladder and/or ureteric injuries (v) small or large bowel injuries. The main causes of bleeding are: tone, tissue, trauma, and thrombin. Care should be taken to avoid inadvertent injury to adjacent structures (ureters and bladder) and these extensions should be secured with haemostatic sutures. Inferior epigastric vessels are notorious for retraction and hence prompt recognition of injury and immediate repair is mandatory to avoid primary surgical haemorrhage and return to theatre. Care should be taken to clamp, cut and ligate omental vessels whilst performing adhesiolysis. It is good practice to always check for bladder injuries after closure of the uterine incision and before closing the peritoneal cavity. Obstetricians should be able to recognise organ damage and repair the injury in low-resource settings.
This chapter discusses the types, implications and management strategies of breech delivery. Breech presentation at time of delivery is associated with increased perinatal mortality and morbidity. Any factor that affects the uterine shape and tone, passenger (fetal size, maturity, structure and number) and passage (both bony pelvis and sot tissues) can predispose to breech presentation. Before allowing vaginal breech delivery it is important to confirm the presenting part by performing a vaginal examination. An episiotomy may be performed as a prophylactic measure when the breech delivery is imminent, even in multiparous women. It has been advocated to prevent possibility of soft tissue dystocia. For simplicity, conduct of assisted vaginal breech delivery will be considered in three parts: Delivery of the legs and buttocks; Delivery of the trunk and shoulders and Delivery of the 'after-coming' head.