Cesarean Delivery: From Surgical Procedure to System of Care

Cesarean delivery has evolved from an operation of last resort to the most frequently performed major surgical procedure worldwide, with nearly 29 million births each year. Advances in anesthesia, surgical technique, and perioperative care have greatly improved safety, yet the expansion of cesarean delivery raises complex clinical, psychological, and societal questions. This article introduces the American Journal of Obstetrics and Gynecology (AJOG) supplement "Cesarean Delivery", which assembles expert reviews, clinical opinions, original research, clinical trials, and perspectives addressing key aspects of this transformation. Topics include preoperative ultrasound to guide incision planning, evolving methods of uterine closure, Enhanced Recovery After Surgery (ERAS) guidelines, management of complex cases such as placenta accreta, and the prevention of infection, hemorrhage, and thromboembolism. This issue introduces a new quality index that evaluates outcomes for the maternal-newborn dyad, integrating cesarean rate with both maternal and neonatal outcomes to provide a more meaningful measure of obstetric performance. Psychological sequelae such as post-traumatic stress disorder and postpartum depression, and neonatal consequences of elective and preterm cesarean deliveries are also discussed. Collectively, these contributions redefine cesarean delivery as part of an integrated continuum of care-one that values surgical technique, maternal and infant outcomes, and the ethical balance between safety and autonomy.