Ultrasound Assessment Before Complex or Difficult Cesarean Section

Complex or difficult cesareans are associated with significant short- and long-term complications. The complications rate increases with increasing number of cesareans, and the incidence of cesarean section is increasing. To accurately identify women at high risk of surgical difficulty during a cesarean, ultrasound, in addition to clinical assessment, can be used to evaluate many risk factors including placenta previa, placenta accreta spectrum (PAS) disorders, fibroids, severe pelvic adhesions and membranous fetal vessels. Ultrasound is a well-established practice in obstetrical care as ultrasound is easily available, accessible, easy to perform, and well acceptable to the women. However, there are few studies on the role of preoperative ultrasound in the management of complex or difficult cesareans beyond the risk assessment of PAS. Currently, preoperative ultrasound is performed in selected cases only. The aim of this review article is to discuss the benefits and the use of ultrasound assessment before different types of complex or difficult cesareans. Whether ultrasound assessment should be performed before all cesarean sections will also be discussed.