The lower segment caesarean section, commonly referred to as LSCS, is one of the most frequently performed surgical procedures in obstetrics. It involves delivering a baby through an incision made in the lower segment of the uterus, which is the thinner, less vascular part compared to the upper segment. This procedure is widely preferred due to its lower risk of bleeding, faster healing, and reduced chances of complications for both the mother and baby. Over the years, LSCS has become a standard and safe alternative to classical caesarean sections, particularly in cases where vaginal delivery is not feasible or poses a risk to maternal or fetal health.
Indications for Lower Segment Caesarean Section
There are several medical indications for performing an LSCS. These indications are broadly categorized into maternal, fetal, and combined maternal-fetal factors. Understanding these indications helps healthcare providers decide when a surgical approach is necessary for safe delivery.
Maternal Indications
- Previous caesarean section, especially with a classical incision
- Pelvic deformities or contracted pelvis preventing vaginal delivery
- Placenta previa or abnormal placental implantation
- Severe maternal medical conditions such as cardiac disease, hypertension, or infections that make labor risky
Fetal Indications
- Fetal distress detected through abnormal heart rate patterns
- Malpresentation, including breech or transverse lie
- Multiple gestations where vaginal delivery may pose a risk
- Macrosomia or large for gestational age babies that may not pass safely through the birth canal
Combined Maternal-Fetal Indications
- Prolonged labor not progressing despite adequate contractions
- Umbilical cord prolapse
- Obstructed labor due to fetal-pelvic disproportion
Preparation for the Procedure
Before performing an LSCS, both the mother and healthcare team need to prepare carefully. Preoperative evaluation includes reviewing maternal history, conducting physical and laboratory examinations, and ensuring fetal well-being. Informed consent is obtained after discussing the procedure, risks, benefits, and alternatives. Typically, regional anesthesia such as spinal or epidural anesthesia is preferred because it allows the mother to be awake during delivery while minimizing risks associated with general anesthesia. Additionally, prophylactic antibiotics are often administered to reduce the risk of postoperative infection.
Steps in Performing Lower Segment Caesarean Section
The LSCS procedure follows a standardized surgical approach to ensure safety and efficiency. The main steps include incision, delivery, and closure.
Incision
The surgeon typically makes a transverse incision in the lower uterine segment, just above the bladder. This incision is horizontal and relatively small, reducing bleeding and allowing better healing. The skin, subcutaneous tissue, and fascia are carefully dissected to expose the uterus. Care is taken to avoid injury to the bladder and surrounding structures.
Delivery of the Baby
Once the uterus is opened, the amniotic fluid is drained, and the baby is gently delivered through the incision. Immediate assessment of the newborn is performed by the pediatric team, including checking vital signs and the Apgar score. The umbilical cord is clamped and cut, and the baby is handed to the neonatal team for care.
Placenta Removal and Uterine Closure
After delivering the baby, the placenta is carefully removed, and the uterine cavity is inspected for any residual tissue or bleeding. The uterus is then sutured in layers to ensure hemostasis and structural integrity. Finally, the abdominal wall is closed layer by layer, including fascia, subcutaneous tissue, and skin. In some cases, subcuticular sutures or staples are used for better cosmetic results.
Postoperative Care
After LSCS, careful postoperative monitoring is essential for maternal recovery and prevention of complications. Pain management, usually through oral or intravenous analgesics, is provided. Early mobilization is encouraged to prevent thromboembolic events. Mothers are also monitored for signs of infection, bleeding, or urinary complications. Lactation support is provided to encourage early breastfeeding, which is beneficial for both mother and child.
Benefits of Lower Segment Caesarean Section
Compared to classical caesarean sections, LSCS offers multiple benefits, making it the preferred approach in modern obstetric practice.
- Lower risk of hemorrhage due to reduced vascularity in the lower uterine segment
- Faster healing and recovery time, allowing earlier mobilization
- Reduced risk of uterine rupture in subsequent pregnancies
- Less postoperative pain and improved cosmetic outcomes with transverse incisions
- Decreased adhesion formation between the uterus and abdominal organs
Risks and Complications
Although LSCS is generally safe, it carries certain risks that need to be considered.
Maternal Risks
- Postoperative infection, including wound infection or endometritis
- Hemorrhage or need for blood transfusion
- Thromboembolic events such as deep vein thrombosis or pulmonary embolism
- Injury to surrounding organs including bladder, bowel, or blood vessels
- Adhesion formation potentially affecting future fertility or surgeries
Neonatal Risks
- Respiratory distress due to delayed lung fluid clearance
- Prematurity if the procedure is performed before term
- Minor surgical injuries during extraction in rare cases
Recovery and Follow-Up
Recovery after LSCS usually involves a hospital stay of 2-5 days, depending on maternal and neonatal condition. Mothers are advised on wound care, activity restrictions, and signs of infection. Follow-up visits help monitor healing and provide guidance on family planning and subsequent pregnancies. Physical activity is gradually increased, and mothers are encouraged to maintain proper nutrition and hydration to support recovery. Emotional support and counseling may also be beneficial, particularly for women experiencing anxiety or stress after surgical delivery.
Lower segment caesarean section is a safe and commonly performed surgical procedure that provides a reliable method for delivering babies when vaginal birth is not advisable or possible. Its advantages include reduced bleeding, faster recovery, and lower risk of complications compared to classical caesarean sections. Proper patient selection, careful surgical technique, and diligent postoperative care are essential to optimize outcomes for both mother and baby. As modern obstetric practices continue to evolve, LSCS remains a cornerstone procedure ensuring maternal and neonatal safety during childbirth.