Acute and chronic complications of cesarean delivery: An update for the general radiologist

Cesarean section has become a frequent mode of delivery in the last few decades. While generally regarded as a safe procedure, it is not free of potential complications, often requiring imaging for proper diagnosis with a variety of modalities encompassing mainly ultrasound (transabdominal or transvaginal), computed tomography, and magnetic resonance imaging. It is fundamental for radiologists to be familiar with the expected post-operative changes that may be encountered following cesarean section in order not to misinterpret them for pathology. In general, complications may be subdivided into acute and chronic. Acute complications comprise mainly infections (including endometritis and abscess formation), hemorrhage and hematomas (which tend to occur in predictable locations, such as within the rectus sheath or at the level of the bladder flap), uterine dehiscence or rupture, and injury to adjacent structures (namely the urinary tract). Chronic complications may present years after surgery and include postoperative adhesions, incisional hernias, cesarean scar defects, placenta accreta spectrum disorders, cesarean scar ectopic pregnancy, cesarean scar retained products of conception, and abdominal wall endometriosis. MRI has a pivotal role in the characterization of such chronic complications in adjunct to ultrasound. This review article first discusses normal imaging findings following cesarean section and then provides an update on manifestations of its various possible complications, in both the acute and chronic setting, with the aim of serving as a general vademecum for radiologists who are not specialized in gynecologic imaging, in light of the increasing likelihood of encountering these entities in routine practice.