Early and delayed post-cesarean complications: an imaging review

Cesarean delivery is a common procedure, currently accounting for one-third of live births in the US. In the acute post-operative setting, it can be difficult to distinguish changes of the expected recovery of the uterus from those of complications. A radiologist should be able to recognize expected postoperative findings and their evolution, such as endometrial cavity debris, small hematoma, or peri-incisional edema, when interpreting images at various stages of recovery. Commonly seen acute complications after cesarean delivery include subfascial and bladder flap hematomas, uterine dehiscence or rupture, endometritis, septic thrombophlebitis, retained products of conception, and vascular complications such as uterine artery pseudoaneurysm, arteriovenous fistula, and ovarian vein thrombosis. On the contrary, delayed complications include uterine scar niche, cesarean scar ectopic pregnancy, endometriosis, pelvic inflammatory disease, bowel obstruction, that occur beyond the post-partum period and are often manifested during subsequent pregnancies. This review aims to familiarize radiologists with the pathophysiology and timeline of the expected post-cesarean imaging findings and complications, to aid accurate diagnosis and prompt patient management.