A vertical uterine
incision causes less
bleeding and better
access to the fetus, but
renders the mother
unable to attempt a
vaginal delivery (must
have another repeat C-
section) in the future.
C-section : Procedure-3
Finally, the
surgeon cuts through
the amniotic sac
enclosing the baby.
He then allows the
amniotic fluid to
escape.
C-section : Procedure-5
C-section : Procedure-6
Cesarean Childbirth-Possible
Complications
Recommended by WHO
Reproductive Health Library as
Minimally Invasive Method for a
commonest surgical procedure
done Worldwide.
Cesarean Delivery Ancient
Medical History
Evidence based Cesarean delivery-
Misgav Ladach Technique
Caesarean Section has been a part of human culture since
ancient times and there are tales in both western and non-
western culture of this procedure.
/\
Midway between
umbilicus & symphysis
pubis.
Separation of recti easy
Evidence based Cesarean delivery-
Misgav Ladach Technique
Principles :
Behind Joel Cohen incision as well as other steps are - the
approach to handling the muscles blood vessels and nerves
They are treated like the strings on the musical instruments, where
the more distant you move from the insertion, the easier is the
lateral stretching due to elasticity, and therefore the damage is
reduced.
Evidence based Cesarean delivery-
Misgav Ladach Technique
Why ?
Pfannenstiel incision takes longer to make and
longer to repair
More adhesions
Evidence based Cesarean delivery-
Misgav Ladach Technique
Steps Of C - Section:
Space in between
allows draining of
secretions
Evidence based Cesarean delivery-
Misgav Ladach Technique
Quick recovery
Post operative pain quite less
Fewer adhesions
Reduced scarring.
Evidence based Cesarean delivery-
Misgav Ladach Technique
Evidence based Cesarean delivery-
Misgav Ladach Technique
COST benefits
Cost beneficial
Exteriorization of uterus
Two layer uterus closure
Peritoneal suturing
Routine antibiotics
Uterotonics/Oxyticics
Evidence based Cesarean delivery-
Misgav Ladach Technique
Technique of CS : Issues
Regional Vs. General anesthesia
Indwelling vs. intermittent catheter
Lateral tilt to operation table
Manual removal of placenta Deprecated
Post-operative wound drainage
Evidence based Cesarean delivery-
Misgav Ladach Technique
Extra abdominal vs. intra abdominal repair of uterine
incision
6 trials 1221 cases of Emergency + Elective CS
Outcome measures: Blood loss, Sepsis, Costs,
Satisfaction etc.
Marginal drop in febrile morbidity in exteriorization
group
Hematocrit drop similar
Sepsis similar
Evidence based Cesarean delivery-
Misgav Ladach Technique
Peritoneal Closure
Authors Conclusion
Authors Conclusion
Authors Conclusion
Authors Conclusion
FETUS MOTHER
Childbirth
Who are involved ?
FETUS MOTHER
Obstetrical
Midwives Uni-Hospital
Society
Published rates
W.H.O.: 1
15 %
Maximum desirable rate of cesarean section
No benefit for mother and the fetus for
medical reasons
1 World Health Organisation. Appropriate technology for birth. Lancet 1985;4367.
Factors involved in decision
1. Fetal mortality and morbidity
2. Newborn health
3. VBAC
4. Cost
5. Pelvic floor damage
6. Maternal mortality
7. Cultural factors
8. Autonomy - C-section on demand?
Factors involved in decision
1. Fetal mortality and morbidity
2. Newborn health
3. VBAC
4. Cost
5. Pelvic floor damage
6. Maternal mortality
7. Cultural factors
8. Autonomy - C-section on demand?
Unexplained fetal deaths
Cotzias C, Paterson-Brown S, Fisk N. BMJ, 319,31 july
1999
1: 664 forceps
1: 860 vacuum extraction
1: 907 c-section during labor
1: 1900 delivered spontaneously
1: 2750 c-section with no labor
Conclusion: The common risk factor for
hemorrhage is abnormal labor
Factors involved in decision
1. Fetal mortality and morbidity
2. Newborn health
3. VBAC
4. Cost
5. Pelvic floor damage
6. Maternal mortality
7. Cultural factors
8. Autonomy - C-section on demand?
Frequency of cesarean section, primary cesarean and vaginal birth
post-c-section between 1989 - 2001
VBAC
30
25
All c-sections
20
% 15 Primary c-section
10
5
0
89 91 93 95 97 99 2001
Ao
cesarean birth.
Child: + $ 2.000
Factors involved in decision
1. Fetal mortality and morbidity
2. Newborn health
3. VBAC
4. Cost
5. Pelvic floor damage
6. Maternal mortality
7. Cultural factors
8. Autonomy - C-section on demand?
Pelvic floor
Urinary incontinence
Fecal incontinence
Sexual dysfunction
Organ prolapse
Pelvic floor
Minimizing episiotomies
E-mail : kasinamrao@gmail.com