Abstract

Twenty-nine million cesarean deliveries performed every year. Although often regarded as routine, even elective procedures can lead to serious complications for mothers and infants. Modern patient safety emphasizes that no incision should be undertaken without knowing what lies beneath, a principle codified by the World Health Organization in its Surgical Safety Checklist. A preoperative ultrasound represents an extension of this principle to obstetrics. Several complications exemplify face-valid safety signals: incision through an anterior placenta with maternal hemorrhage and neonatal anemia; undiagnosed vasa previa with the risk of transecting fetal vessels; fibroids obstructing entry into the uterus; malpositions; uterine scar dehiscence altering incision strategy; and unexpected adnexal masses, including malignancy. A deeply impacted fetal head represents a particularly high-risk scenario that has become more frequent with prolonged second-stage labor. Ultrasound performed immediately before surgery can identify fetal head deflexion and guide modification of the uterine incision to facilitate safe entry, informing selection of obstetric maneuvers such as manual vaginal disimpaction, reverse breech extraction, the Patwardhan technique, or use of adjunct devices for atraumatic delivery. During the surgical time-out, reviewing ultrasound findings enables the team to confirm placental location, fetal lie, head position and attitude, and any pathology that may alter the surgical approach. This practice embodies the principles of patient safety-anticipating hazards before they cause harm-and supports a culture of preparedness in cesarean delivery.