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CESAREAN SECTION

By
Zahraa majeed
DEFINITION

 The delivery of a viable fetus through an incision in


the abdominal wall and uterus. Definition does not
include removal of fetus from abdominal cavity in
case of rupture uterus.
 WHO recommends an ideal caesarean rate of 10-
25%..........
WHY RATES INCREASED?
 Increase in repeat caesareans.
 Difficult instrumental delivery and vaginal breech
deliveries
 Increased diagnosis of intrapartum fetal distress
Caesarian on demand
 Identification of risk of mothers and fetuses
 Increase in pregnancies by invitro fertilization
TYPES OF CS
 Lower uterine segment incision (LSCS) :
 This is the commonest CS procedure. Involved
horizontal incision after reflecting visceral
peritoneum. the abdomen is opened by a low
midline ,paramedian and more commonly by a
pfannenstiel incision and peritoneal cavity opened.
the bladder is reflected from the lower segment and
transverse incision is made on the lower uterine
segment care being taken not to injured the fetus.
 The forceps can be used to assist delivery in a
cephalic presentation.
 (LSCS) is commonest procedure because it easier
to incise the lower segement , deliver the fetus
from point of incision
 and to approximate the layers because of thin
muscle layers compared with upper segement .in
addtion the peritoneal layer can be closed and was
thought to provid advantage against infection .also
blood loss with LSCS is less.

Midline vertical incision

 Commonly starts in the lower segment as a small


buttonhole incision till the uterine cavity is reached
and is extended upwards .because the difficulty the
making the incision , increased blood loss ,
inadequate approximation at closure , increase post-
operative morbidity and inability to offer a trial of
vaginal delivery in the next pregnant due to possible
higher incidence of scar rupture .
Indications for classical incision:
 Transverse lie with SROM

 Structural abnormality that makes lower segment


approach difficult
 Constriction ring with neglected labour
 Fibroids in the lower segment
 Ant PP & abnormally vascular lower segment
 Mother dead & rapid delivery is required
 Very preterm fetus in breech pres
INDICATIONS FOR ELECTIVE CS

 Known CPD  Uterine surgery eg.


 Fetal macrosomia > Hystrotomy,
4500 gm myomectomy
 Placenta previa  Severe IUGR
 VV fistula repair  Breech
 HIV  Multiple pregnancy
 Active herpes  Transverse lie
 Repeat CS  Ca of the Cx/ TR
obstructing the birth
canal
INDICATIONS FOR EMERGRENCY CS

 Severe PET
 Abruptio placntae
 Fetal distress
 Failure to progress in the first stage of labour
 Cord prolapse
 Obstructed labour
 Failed induction
 Malpresentation  brow, chin post, shoulder &
compound presentations, breech
 Compromised fetus 2ry to DM, HPT,
isoimmunization
 APH
Urgent CS

 There is maternal and fetal compromised but not


life threatening .here delivery should be complteted
within 60-75 min and cases with FHR abnormalities
are those of concern.

 Sechualed CS
 The mother need early delivery but not maternal or
fetal compromised there may concern that
continuation of pregnancy is likely affect the mothe
or fetus in hours or days to come.
COMPLICATIONS
INTRAOPERATIVE
 Bleeding & the need for bl transfusion
 Hysterectomy
 Complications of anaesthesia
 Damage to the bladder, ureter, colon , retained placental
tissue
 Fetal injury
POSTOPERATIVE
 Gaseous distension
 Paralytic ileus
 Wound dehiscence & infection
 Infectins  UTI, pulmonary
 DVT & pulmonary embolism
 Death
 Vesico uterine fistula
POSTNATAL CARE
 V/S & blood loss must be monitered
 Uterine fundus palpated
 Effective parentral analgesics
 Deep breathing & coughing encouraged
 Early mobilization
 Fluid therapy &diet
 Bladder & bowel function
 Wound care
 Lab
 Breast care
 Prophylaxis for thrombembolism
MODE OF DELIVERY IN NEXT
PREGNANCY
CRITERIA FOR VBAC
 Pt must agree to the procedure
 A low transverse uterine incision
 Non recurrent cause of the previous CS
 No macrosomia, malposition, multiple gestation,
breech
Contraindication
 Previous classical CS
 2 or more previous CS
 Previous other uterine surgery
 Hx of scar rupture
 Placentaprevia or transverse lie
SCAR RUPTURE
 O.2-1.5% for LSCS
 4-9% for classical

INDICATIONS OF SCAR RUPTURE


 Fetal distress

 Ease of fetal palpation

 Cessation of contractions

 Elevation of presenting part

 Scar pain

 Bleeding / shock
The end