LATE-STAGE FOLLOW-UP AFTER CESAREAN DELIVERY: A 12-MONTH MONITORING AND TARGETED INTERVENTION PATHWAY (WOUND/SSI, LACTATION AND EPDS, SCAR HEALING BY RMT/NICHE, PELVIC FLOOR FUNCTION, AUB, AND TOLAC/VBAC PLANNING)

Abstract

Post-cesarean care is frequently concentrated on the early postoperative window; however, clinically meaningful morbidity often extends far beyond hospital discharge. Key late-stage domains include (1) surgical-site infection (SSI) recognition after discharge, (2) persistent pain and anemia-related symptoms, (3) lactation difficulties and functional recovery, (4) perinatal mental health conditions requiring structured screening, (5) pelvic floor dysfunction, and (6) abnormal uterine bleeding (AUB) associated with cesarean scar niche (isthmocele) and reduced residual myometrial thickness (RMT). These issues directly influence quality of life and shape counseling for subsequent pregnancies, including trial of labor after cesarean (TOLAC) and vaginal birth after cesarean (VBAC). WHO postnatal care guidance recommends multiple postnatal contacts, including between 7–14 days and around 6 weeks, but structured pathways that explicitly extend follow-up through 12 months remain inconsistently implemented in routine practice.