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. Graphical abstract Data availability No datasets were generated or analysed during the current study.

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We would like to thank Dr Mindy Horrow, MD for her help and cases. Author information Authors and Affiliations Contributions NZ = Literature review and wrote the manuscript AP = Conception and critical review AE = Critical review MR = Critical review YA = Conception, prepared the figures, and critical review. Corresponding author Ethics declarations Competing interests : The authors received no dedicated funding in direct support of the preparation of this manuscript. The authors have no financial or non-financial disclosures relevant to this work. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Zacharias, N.A., Panda, A., Elmahdy, A. et al. Early and delayed post-cesarean complications: an imaging review. Abdom Radiol 51, 1489–1505 (2026). https://doi.org/10.1007/s00261-025-05118-0 Received: Revised: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00261-025-05118-0