Birth - Caesarean Delivery

From Embryology


Birth caesarean.jpg

The term "caesarean" comes from the historic description of Julius Ceasar's birth, though probably ficticious as his mother Aurelia survived his birth. The procedure involves surgically cutting skin, abdominal wall and uterus to allow abdominal delivery.

The rate of caesarean delivery compared to normal vaginal birth is variable between countries (12-25%, 20% of all births in Australia) and increasing, particularly in older women. There are a number of different explanations as to why this is occuring, including maternal or fetal complications of either development or delivery.

Importantly this is a maternal surgical procedure which requires time for recovery and there are several studies that have looked also into the effects of caesarean delivery on potential future normal vaginal births.

Please note the UK/Australian "Caesarean" versus USA "Cesarean" spelling differences. Clinically, cesarean section may also be abbreviated to c-section or C/S.

Video Webcast: Hartford Hospital Cesarean Childbirth (September 23rd, 2005)

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Historic Birth links  
1921 USA Birth Mortality

Some Recent Findings

  • Could Revision of the Embryology Influence Our Cesarean Delivery Technique[1] "Until today, there is no standardized Cesarean Section method and many variations exist. The main variations concern the type of abdominal incision, usage of abdominal packs, suturing the uterus in one or two layers, and suturing the peritoneal layers or leaving them open. One of the questions is the optimal location of opening the uterus. Recently, omission of the bladder flap was recommended. The anatomy and histology as results from the embryological knowledge might help to solve this question. The working thesis is that the higher the incision is done, the more damage to muscle tissue can take place contrary to incision in the lower segment, where fibrous tissue prevails. In this perspective, a call for participation in a two-armed prospective study is included, which could result in an optimal, evidence-based Cesarean Section for universal use."
  • Does the presence of a Caesarean section scar affect implantation site and early pregnancy outcome in women attending an early pregnancy (12 weeks gestation) assessment unit?[2]"Implantation was most frequently posterior (53%) in the CS group and fundal in the non-CS group (42%). Gestation sac implantation was 8.7 mm lower in the CS group. Presenting complaints differed in women with and without a previous CS (P = 0.0009). More frequent vaginal bleeding yet no clearly increased spontaneous abortion rates were noted in the CS group compared with the non-CS group. A weakness of the study is the lack of a reference technique to verify the location of implantation."
  • NIH Consensus Development Conference Draft Statement on Vaginal Birth After Cesarean: New Insights[3]
  • WHO global survey on maternal and perinatal health in Latin America: classifying caesarean sections[4] "Caesarean section (CS) rates have increased significantly worldwide during the last decades but in particular in middle and high income countries. In several countries of Latin America, the proportion of deliveries by CS is approaching 40% at national level. In United States, the CS rate in 2006 was 31.1%, and the latest estimates for several European countries are also above 30%. This steady increase has fuelled the debate over acceptable rates of CS and the risk-benefit analysis in ensuring optimum maternal and perinatal outcomes in different populations with different access to health resources."
  • Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08.[5] "To improve maternal and perinatal outcomes, caesarean section should be done only when there is a medical indication."
  • Trends and determinants of caesarean sections births in Queensland, 1997-2006.[6] "In Queensland, in 2006, CS rates were 26.9 and 48.0% among public and private sector patients, respectively. ....The CS rate in Queensland in 2006 was higher than in any other Australian state. The increase in Queensland's CS rates can be attributed to both the rising number of primary caesarean births and the rising number of repeat caesareans."
  • Long-term maternal morbidity associated with repeat cesarean delivery[7] "Concern regarding the association between cesarean delivery and long-term maternal morbidity is growing as the rate of cesarean delivery continues to increase. Observational evidence suggests that the risk of morbidity increases with increasing number of cesarean deliveries. The dominant maternal risk in subsequent pregnancies is placenta accreta spectrum disorder and its associated complications. A history of multiple cesarean deliveries is the major risk factor for this condition. Pregnancies following cesarean delivery also have increased risk for other types of abnormal placentation, reduced fetal growth, preterm birth, and possibly stillbirth."
More recent papers
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  • Therefore the list of references do not reflect any editorial selection of material based on content or relevance.
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Search term: Caesarean Birth

David M Haas, Sarah Morgan, Karenrose Contreras, Savannah Enders Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database Syst Rev: 2018, 7;CD007892 PubMed 30016540

Enoch Odame Anto, William K B A Owiredu, Samuel Asamoah Sakyi, Cornelius Archer Turpin, Richard K D Ephraim, Linda Ahenkorah Fondjo, Christian Obirikorang, Eric Adua, Emmanuel Acheampong Adverse pregnancy outcomes and imbalance in angiogenic growth mediators and oxidative stress biomarkers is associated with advanced maternal age births: A prospective cohort study in Ghana. PLoS ONE: 2018, 13(7);e0200581 PubMed 30016351

Lin Jing, Gu Wei, Song Mengfan, Hou Yanyan Effect of site of placentation on pregnancy outcomes in patients with placenta previa. PLoS ONE: 2018, 13(7);e0200252 PubMed 30016336

Shigeki Matsubara, Hironori Takahashi, Hitoshi Yano Letter to 'Ring compression suture for controlling post-partum hemorrhage during cesarean section': Some additions. J. Obstet. Gynaecol. Res.: 2018; PubMed 30015366

Raymond Li, Jade Lodge, Christopher Flatley, Sailesh Kumar The burden of adverse obstetric and perinatal outcomes from maternal smoking in an Australian cohort. Aust N Z J Obstet Gynaecol: 2018; PubMed 30014485

USA Caesarean Rate by Gestational Age

Latest 2013 data[8]

USA Cesarean Births 2013.jpg USA cesarean rate by gestational age.jpg

Trial of Labor

Trial of Labor (TOL) or trial of labor after cesarean (TOLAC) is a term used in relation to the offer for a normal vaginal delivery after a previous cesarean delivery. The resulting birth is described as vaginal birth after cesarean (VBAC), in recent years this option has been decreasing while the general caesarian rate increases.

USA data - Vaginal birth after cesarean.jpg

Positive Factors

(increased likelihood of successful VBAC)

  • Maternal age <40 years
  • Prior vaginal delivery (particularly prior successful VBAC)
  • Favorable cervical factors
  • Presence of spontaneous labor
  • Nonrecurrent indication that was present for prior cesarean delivery

Negative Factors

(decreased likelihood of successful VBAC)

  • Increased number of prior cesarean deliveries
  • Gestational age >40 weeks
  • Birth weight >4,000 g
  • Induction or augmentation of labor

Links: USA Guideline (2005) | NIH Consensus - Vaginal Birth After Cesarean (2010)

Caesarean Classification

Distribution of the 73 articles on Robson's classification according to country of origin.[9]

There is no standard clinical classification system for caesarean delivery, with at least 27 classifications identified.[10] Recent studies of data from several countries[9] suggests that the 10 group classification system (Robson Classification[11]), or a modification of this system, may be the current best applied system.

Robson Classification

The Robson's classification[11] (10 group classification) is based on several simple obstetrical parameters; parity, previous CS, gestational age, onset of labour, fetal presentation and the number of foetuses. The classification categories are totally inclusive and also mutually exclusive.

Links: WHO Robson Classification


  1. Stark M, Mynbaev O, Vassilevski Y & Rozenberg P. (2016). Could Revision of the Embryology Influence Our Cesarean Delivery Technique: Towards an Optimized Cesarean Delivery for Universal Use. AJP Rep , 6, e352-e354. PMID: 28078171 DOI.
  2. Naji O, Wynants L, Smith A, Abdallah Y, Saso S, Stalder C, Van Huffel S, Ghaem-Maghami S, Van Calster B, Timmerman D & Bourne T. (2013). Does the presence of a Caesarean section scar affect implantation site and early pregnancy outcome in women attending an early pregnancy assessment unit?. Hum. Reprod. , 28, 1489-96. PMID: 23585560 DOI.
  3. Cunningham FG, Bangdiwala SI, Brown SS, Dean TM, Frederiksen M, Rowland Hogue CJ, King T, Spencer Lukacz E, McCullough LB, Nicholson W, Petit NF, Probstfield JL, Viguera AC, Wong CA & Zimmet SC. (2010). NIH consensus development conference draft statement on vaginal birth after cesarean: new insights. NIH Consens State Sci Statements , 27, 1-42. PMID: 20228855
  4. Betrán AP, Gulmezoglu AM, Robson M, Merialdi M, Souza JP, Wojdyla D, Widmer M, Carroli G, Torloni MR, Langer A, Narváez A, Velasco A, Faúndes A, Acosta A, Valladares E, Romero M, Zavaleta N, Reynoso S & Bataglia V. (2009). WHO global survey on maternal and perinatal health in Latin America: classifying caesarean sections. Reprod Health , 6, 18. PMID: 19874598 DOI.
  5. Lumbiganon P, Laopaiboon M, Gülmezoglu AM, Souza JP, Taneepanichskul S, Ruyan P, Attygalle DE, Shrestha N, Mori R, Nguyen DH, Hoang TB, Rathavy T, Chuyun K, Cheang K, Festin M, Udomprasertgul V, Germar MJ, Yanqiu G, Roy M, Carroli G, Ba-Thike K, Filatova E & Villar J. (2010). Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08. Lancet , 375, 490-9. PMID: 20071021 DOI.
  6. Howell S, Johnston T & Macleod SL. (2009). Trends and determinants of caesarean sections births in Queensland, 1997-2006. Aust N Z J Obstet Gynaecol , 49, 606-11. PMID: 20070708 DOI.
  7. Clark EA & Silver RM. (2011). Long-term maternal morbidity associated with repeat cesarean delivery. Am. J. Obstet. Gynecol. , 205, S2-10. PMID: 22114995 DOI.
  8. Martin JA, Hamilton BE, Osterman MJK, et al. Births: Final data for 2013. National vital statistics reports; vol 64 no 1. Hyattsville, MD: National Center for Health Statistics. 2015.
  9. 9.0 9.1 Betrán AP, Vindevoghel N, Souza JP, Gülmezoglu AM & Torloni MR. (2014). A systematic review of the Robson classification for caesarean section: what works, doesn't work and how to improve it. PLoS ONE , 9, e97769. PMID: 24892928 DOI.
  10. Torloni MR, Betran AP, Souza JP, Widmer M, Allen T, Gulmezoglu M & Merialdi M. (2011). Classifications for cesarean section: a systematic review. PLoS ONE , 6, e14566. PMID: 21283801 DOI.
  11. 11.0 11.1 Robson MS. (2001). Can we reduce the caesarean section rate?. Best Pract Res Clin Obstet Gynaecol , 15, 179-94. PMID: 11359322 DOI.


Caesarean Section NICE Clinical Guidelines, No. 13 National Collaborating Centre for Women's and Children's Health (UK). London: RCOG Press; 2004 Apr. ISBN-10: 1-904752-02-0 Bookshelf


Horey D, Weaver J & Russell H. (2004). Information for pregnant women about caesarean birth. Cochrane Database Syst Rev , , CD003858. PMID: 14974041 DOI.


Milne J, Gafni A, Lu D, Wood S, Sauve R & Ross S. (2009). Developing and pre-testing a decision board to facilitate informed choice about delivery approach in uncomplicated pregnancy. BMC Pregnancy Childbirth , 9, 50. PMID: 19874628 DOI.

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Cite this page: Hill, M.A. (2018, July 18) Embryology Birth - Caesarean Delivery. Retrieved from

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