Month: February 2026

A lower segment cesarean section – LSCS, commonly known as a C-section, is one of the most frequently performed surgical procedures in obstetrics. While it is often planned for specific medical reasons, it may also be performed during emergencies to ensure the safety of both mother and baby. In this Q&A, commonly asked questions related to caesarean are discussed, including when it is recommended, different options for anaesthesia, recovery, and future pregnancies, to help expectant mothers feel informed, prepared, and reassured.

What is lower segment caesarean section? (LSCS)

Delivering your baby through a cut or incision is made in the lower part of your womb and abdomen.

What are the common indications of LSCS?

It may be considered when a vaginal delivery may not be safe for the mother or baby. Some of the indications are:

• When the progress of labour is very slow, or it is not progressing
• When the heart rate or rhythm of your baby is abnormal. (fetal distress)
  Abnormal position and presentation of your baby, i.e., if your baby is positioned bottom first (posterior position, breech, or transverse presentation)
• When the birth canal (bony pelvis) is narrow.
• When there is a disproportion of your pelvis compared to the large head or body of the baby (Cephalopelvic disproportion – CPD)
• Placenta previa – If you have a low lying placenta that covers or lies close to the cervix.
• If the first baby of a twin pregnancy is not presenting by head
  Severe fetal growth restriction – If your baby is too small with Doppler changes (blood flow to the baby)
• History of previous C-section or uterine surgery.

What is the type of anaesthesia preferred for LSCS

• Spinal anaesthesia (most common)
• Combined spinal and epidural anaesthesia.
• Epidural alone.
• General anaesthesia, typically reserved for emergencies, is less commonly preferred.

Can I have a vaginal delivery after a caesarean section (VBAC)?

Yes,60-70% of patients after LSCS have vaginal birth. It depends on factors like the indication of your previous caesarean section, previous and current pregnancy status.

• What should I expect after surgery?
• You will be given fluids through an IV drip.
• You may start drinking fluids after 6 hours of operation.
• You will be having a urinary catheter for draining urine, which will usually be kept till the next morning.
• You will be started on a soft diet once you pass gas..
• Walking will be encouraged within 24 hours to prevent blood clots and to improve mobility.

How to take care of my wound (LSCS wound)?

You will be in the hospital for 2 days after this. The wound is usually covered with a dressing, which will be removed later. The wound area needs to be kept clean and dry for a few days. Avoid applying anything over the wound unless advised by the doctor. Look out for any changes such as redness, swelling or discharge. In most cases, the stitches are absorbable, and dressings are minimal.

Will there be any bleeding after surgery?

Yes, can have on and off bleeding for 10-14 days. It will be heavy at the start and gradually decrease. It may last upto six weeks for some. However, if there is heavy bleeding up to 12 weeks (late postpartum hemorrhage – PPH) or large blood clots, surely consult with your doctor.

When can I resume normal activities?

• You can resume normal activities like walking in the immediate postoperative period (1 to 2 days after the operation)
• You can start driving after 10-14 days after the caesarean section.
• Avoid abdominal exercise up to 3 months and also heavy weight lifting (> 5kg) upto 3 months.
• You can swim after 6-8 weeks after LSCS.
• You can resume sexual activity preferably after 2 months.
• You can start working after 45 days (depending on the recovery).

How many years do we have to wait when planning for the next pregnancy?

Ideally the interval between two deliveries to be 2 years for optimum integrity of your uterine scar.

Uterine fibroids (or leiomyomas) are non-cancerous(benign) growths that can occur in or around the uterus. They are commonly found in women of reproductive age, and may occur as small, asymptomatic nodules or large masses that can cause discomfort.

 Causes for Uterine Fibroids

The exact cause is not known, but many factors can influence their growth –

• Hormonal influence: Estrogen and progesterone stimulate fibroid growth, and hence it commonly develops during the reproductive age and may shrink during menopause.
• Genetic factor: Fibroids often run in families, suggesting a hereditary component.
• Age: Fibroids are commonly seen in women aged between 30 and 50 years.
• Obesity: Higher body mass index (BMI) has been associated with increased risk for fibroids.
• Early onset of menstruation: Those who have had their first period at an early age have a higher chance of fibroid development.
• Lifestyle factors: A diet high in red meat and low in fruits, vegetables, and dairy products may contribute to fibroid growth.

The growth pattern of fibroids can vary widely from one woman to another.

Types of uterine fibroids and their symptoms

Uterine fibroids are classified based on their location inside or outside the uterus. The type and position of the fibroid often determine the symptoms a woman experiences and the treatment approach.

Intramural Fibroids 

They are the most common type and are located inside the muscular wall of the uterus. They can cause heavy menstrual bleeding, pelvic pain, or a feeling of fullness. Large intramural fibroids can enlarge the uterus and affect fertility or pregnancy outcomes.

Submucosal Fibroids

They grow just beneath the inner lining of the uterus and protrude into the uterine cavity. They are often associated with prolonged menstrual bleeding. It can interfere with implantation and fertility. Even small submucosal fibroids can cause significant symptoms.

Subserosal Fibroids

They develop on the outer surface of the uterus and may grow outward and put pressure on the surrounding organs. They commonly cause pelvic pressure, back pain, and urinary issues, and are less likely to affect menstrual bleeding directly.

Pedunculated Fibroids

They grow on a thin stalk either inside or outside the uterus and may twist on their stalk, leading to sudden and severe pain. They can mimic other acute abdominal conditions.

Cervical Fibroids (Less Common)

They are located in the cervix and may cause difficulty during childbirth or discomfort during intercourse. They can also have urinary or bowel issues.

Not all fibroids require treatment, but symptoms that affect daily life or those that show progressive growth often require medical evaluation.

Possible complications of fibroids

When fibroids are left untreated or become significantly large, they may cause the following complications:

• Severe anaemia resulting from heavy bleeding
• Persistent pelvic pain or pressure.
• Urinary or bowel-related issues, such as difficulty emptying the bladder or constipation.
• Fertility challenges
• Increased risk of pregnancy related complications, including pre-term labour, abnormal fetal position, or higher likelihood of cesarean delivery
• Fibroid degeneration, which can cause severe pain and inflammation.

Early diagnosis and treatment help prevent complications and support better long-term outcomes.

Treatment options for fibroids

Today’s fibroid treatment or care includes a wide range of options –  from medical therapy to advanced minimally invasive and non-invasive procedures. The choice depends on symptoms, fibroid size, patient age, any plan for future pregnancy, and overall health.

Medical management

For women with mild symptoms and those nearing menopause, the following treatments may be considered –

• Hormonal medications to reduce bleeding and help shrink fibroids
• GnRH analogues are used to temporarily induce a low estrogen state and shrink fibroids before surgery.
• Medications for help control heavy menstrual bleeding.

These options can reduce symptoms but are not a definitive cure.

Minimally Invasive Surgical Options

These are often preferred for women who require fertility preservation, want to avoid large incisions, or require a quicker recovery.

Laparoscopic Myomectomy

• Removal of fibroids via small abdominal incisions.
• Benefits: less pain, shorter hospital stay, and faster recovery
• Ideal for multiple or deeper fibroids.

Hysteroscopic Myomectomy

• Fibroids inside the uterine cavity are removed through the vagina and cervix using a hysteroscope.
• Benefits: No external incisions, rapid recovery.

Robot-assisted Myomectomy

• Uses robotic technology for enhanced precision.
• Benefits: 3D magnified view, excellent dexterity for complex fibroids, minimal.
• Particularly useful for large fibroids or difficult locations.

Minimally Invasive Non-surgical Procedures

Advances in gynecology have introduced options that don’t require open surgery.

Uterine Artery Embolization (UAE)

• It is a radiological procedure that blocks the blood supply to the fibroids, causing them to shrink
• Benefits: quick recovery, avoids surgical insertion
• Best sorted for symptomatic fibroids in women not seeking pregnancy.

MRI-guided focused ultrasound (MRgFUS)

• Non-invasive Technology using focused ultrasound waves to destroy fibroid tissue under MRI Guidance.
• Benefits: No incisions, minimal downtime

Hysterectomy (Definitive Treatment)

Hysterectomy or surgical removal of the uterus is a definitive option when:

• symptoms are severe
• other treatments are ineffective
• childbearing is complete.

This eliminates fibroids permanently but ends fertility.

Success stories: Real Cases

Case 1: Large degenerated fibroid in a high-risk patient

A patient presented with severe pelvic pain due to a degenerated fibroid measuring 14 cm in a posterior uterine location. Surgery was technically challenging due to

• obesity with a BMI of 45
• difficult and anatomical access.

Despite this, the surgical team successfully removed the fibroid using advanced minimally invasive techniques, ensuring a safe recovery and significant symptom relief.

Case 2: 2 kg fibroid causing pressure symptoms

A 46 year old woman experienced increased urinary frequency and discomfort due to a large 2kg fibroid. As she had completed her family, a hysterectomy was chosen. The procedure was technically demanding due to the size and location of the fibroid, but the surgery was executed successfully, relieving symptoms and greatly improving her quality of life.

How do advanced techniques help in treating fibroids?

Modern and advanced technologies, such as robotic surgery, MgFUS, and uterine artery embolization, have helped in transforming fibroid care by

• reducing incisions and surgical trauma
• shortening hospital stays and faster recovery
• minimising post-operative pain
• potential for preserving fertility

These innovations provide tailored options, giving women more control over their health and treatment outcomes.

Conclusion

Fibroids can range from asymptomatic to significantly life-altering conditions.

With a personalized care plan and access to modern treatment modalities, most women can achieve excellent outcomes – whether through minimally invasive surgery or non-surgical therapies. For more details, kindly contact us.