Caesarean section is the most commonly performed obstetric operation in the world. While the debate continues about the ideal Caesarean section rate, safety and cost remain the main areas of concern. Prophylactic antibiotics and improvements in surgical techniques, aiming at reduced operating time and blood loss, have contributed to the safety of this operation over the years. Obstetrics and gynaecology training programmes should incorporate basic surgical training as well as training for advanced operative competence. Health personnel should take necessary precautions to avoid exposure to hepatitis B and HIV. Prior planning, anticipation and preparedness, adherence to surgical principles and an early call for help, all bring the best results. The method of Caesarean section has remained essentially the same over the years although a few refinements have been made. Cohen's incision for entry, single-layer closure of the uterus and non-closure of both the layers of the peritoneum are recommended. Many of these changes discussed in this chapter have been tested in randomized trials. Further studies are needed to select the optimal package for performing a Caesarean section.
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