Essential anatomical knowledge for performing routine and complex cesarean delivery

A precise understanding of pelvic anatomy is essential for managing routine and complex obstetrical conditions. This review highlights anatomical domains critical to obstetric practice, including the abdominal wall, parametrial space, vesicouterine pouch, retropubic space, and pelvic vasculature. The parametrial space, housing the uterine artery, ureter, and branches of the internal iliac system, presents with notable variability and is central to managing placenta accreta spectrum, uterine lacerations, intraligamentary hematomas, and fibroids. The internal iliac arterial system forms a complex anastomotic network that enables effective hemostasis and informs surgical strategy. Contemporary anatomical research challenges traditional models of uterine perfusion, underscoring the significance of the inferior uterine anastomotic network, particularly in maintaining perfusion after bilateral uterine artery ligation. Awareness of posterior uterine anastomoses further refines surgical planning in posterior placenta accreta spectrum and low-posterior leiomyomas. Effective management of cesarean complications and obstetrical emergencies requires integration of detailed anatomical knowledge with surgical expertise and resource coordination. Applied anatomy remains foundational to improving clinical outcomes and enhancing patient safety in high-acuity obstetrical care.