Caesarean section

Август 4, 2022

Содержание

2. CAESAREAN SECTION It is an operative procedure to deliver the fetus through an abdominal and uterine
3. CAESAREAN SECTION INDICATIONS Cephalo-pelvic disproportion Fetal malpresentations Previous caesarean section Fetal distress Placenta praevia Abruptio placentae
4. CAESAREAN SECTION INDICATIONS Failed induction Premature rupture of membranes Post datism Pre eclampsia Gestational Diabetes mellitus
5. CAESAREAN SECTION INDICATIONS Vaginal delivery contraindicated Previous classical Caesarean section / uterine scar in upper segment
6. CAESAREAN SECTION Common indications Previous Caesarean Labour dystocia Fetal distress Cephalopelvic disproportion Malpresentations ( esp. Breech)
7. CAESAREAN SECTION Incidence - Varies from 15% to 30% Rise in incidence is due to Increased
8. CAESAREAN SECTION Contraindications : Valid in the absence of maternal indications of abdominal delivery Intrauterine fetal
9. TIMING OF CAESAREAN SECTION ELECTIVE When the caesarean section is done as a planned procedure to
10. LOWER SEGMENT CAESAREAN SECTION Preoperative actions Valid informed consent Inj Ranitidine 50 mg IV half to
11. LOWER SEGMENT CAESAREAN SECTION ANAESTHESIA Spinal Epidural GA POSITION Dorsal position 15 degree lateral tilt to
12. LOWER SEGMENT CAESAREAN SECTION Abdominal cleaning and draping Abdominal incision Transverse ( Pfannensteil / Joel-Cohen) Post
13. LOWER SEGMENT CAESAREAN SECTION Uterine incision Lower segment transverse Apposition better Lesser bleeding due to less
14. CLASSICAL CAESAREAN SECTION INDICATIONS Access to lower uterine segment is restricted because of adhesions Lower segment
15. LOWER SEGMENT CAESAREAN SECTION Doyen’s retractor is introduced in the lower part of the abdominal incision
16. LOWER SEGMENT CAESAREAN SECTION The presenting part is hooked by the operator and delivered while the
17. POST OPERATIVE CARE Nil orally for 24hrs Crystalloids for 24 hrs (appx 2500ml) Antibiotics as per
18. POST OPERATIVE CARE Palpate the uterine fundus Location Consistency Encourage early breast feeding Oral fluids after
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CAESAREAN SECTION
It is an operative procedure to deliver the fetus through

an abdominal and uterine incision, after the period of viability

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CAESAREAN SECTION
INDICATIONS
Cephalo-pelvic disproportion
Fetal malpresentations
Previous caesarean section
Fetal distress
Placenta praevia
Abruptio placentae (with live

fetus)
Dystocia (Ineffective or prolonged labour)
Cord prolapse
Failed trial of Forceps / Vacuum delivery
Fetal malformations likely to cause obstructed labour
High order multifetal gestation

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CAESAREAN SECTION
INDICATIONS
Failed induction
Premature rupture of membranes
Post datism
Pre eclampsia
Gestational Diabetes mellitus
Intra

uterine growth restriction
Rh isoimmunization
Previous unexplained IUFD

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CAESAREAN SECTION
INDICATIONS
Vaginal delivery contraindicated
Previous classical Caesarean section / uterine scar in

upper segment
Contracted pelvis
Placenta praevia
Previous VVF repair / Stress incontinence repair
Cord presentation
Fetal compromise
Pregnancy with Carcinoma cervix
Fibroid / Ovarian tumor causing obstruction
Genital tract malformations of the cervix / vagina

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CAESAREAN SECTION
Common indications
Previous Caesarean
Labour dystocia
Fetal distress
Cephalopelvic disproportion
Malpresentations ( esp. Breech)
Failure of

induction
Antepartum haemorrhage

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CAESAREAN SECTION
Incidence - Varies from 15% to 30%
Rise in incidence is due to
Increased

safety of the procedure
Decrease in parity ( Proportion of nulliparas is more)
Older / Infertile / High risk women are having children
Previous Caesarean sections
Increased detection of fetal distress by EFHRM
Breech presentations predominantly delivered by LSCS
Decrease in difficult operative vaginal deliveries
Concern for malpractice litigation
Improving socio economic status

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CAESAREAN SECTION
Contraindications : Valid in the absence of maternal indications of

abdominal delivery
Intrauterine fetal death
Gross congenital malformations
Extreme prematurity
Coagulation defect

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TIMING OF CAESAREAN SECTION
ELECTIVE
When the caesarean section is done as a

planned procedure to ensure optimal preoperative preparation and surgical conditions
EMERGENCY
When the caesarean section is done because of sudden deterioration in maternal / fetal condition or during labour due to non progress / failed induction / failed trial

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LOWER SEGMENT CAESAREAN SECTION
Preoperative actions
Valid informed consent
Inj Ranitidine 50 mg IV

half to one hour before the procedure
Inj Metoclopramide 10 mg IV half to one hour before the procedure
Stomach should be empty
Bladder should be catheterized
Fetal presentation, position and FHS should be checked

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LOWER SEGMENT CAESAREAN SECTION
ANAESTHESIA
Spinal
Epidural
GA
POSITION
Dorsal position
15 degree lateral tilt to prevent

supine hypotension / venocaval compression may be given

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LOWER SEGMENT CAESAREAN SECTION
Abdominal cleaning and draping
Abdominal incision
Transverse ( Pfannensteil /

Joel-Cohen)
Post op pain is less
Less chance of wound dehiscence / incisional hernia
Cosmetically better
Vertical infraumbilical midline
Rapid entry into abdomen
Capable of extention
Blood loss minimal

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LOWER SEGMENT CAESAREAN SECTION
Uterine incision
Lower segment transverse
Apposition better
Lesser bleeding due to

less vascularity
Less active uterine segment
Healing better
Stretch during subsequent pregnancy is along the line of incision
Chances of rupture during subsequent pregnancy / labour are less
Classical ( Upper segment vertical )

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CLASSICAL CAESAREAN SECTION
INDICATIONS
Access to lower uterine segment is restricted because of

adhesions
Lower segment approach is not possible due to
Anterior placenta praevia
Large fibroids in the lower uterine segment
Transverse lie ( Dorso inferior positions)
Pregnancy with Carcinoma cervix
Post mortem caesarean section

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LOWER SEGMENT CAESAREAN SECTION
Doyen’s retractor is introduced in the lower part

of the abdominal incision to expose the lower uterine segment
Recognition of lower uterine segment is by the presence of loose peritoneum over it
The loose peritoneum is incised transversely and the bladder is pushed down
Lower uterine segment incision should be made after centralizing the uterus to avoid injury to the uterine vessels coursing along the lateral walls of the uterus
Lower uterine segment incision is made in the middle, deepened till the membranes are reached and then extended laterally by stretching to create a 10 cm opening

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LOWER SEGMENT CAESAREAN SECTION
The presenting part is hooked by the operator

and delivered while the assistant applies fundal pressure
The placenta and membranes are delivered and the inside of the uterus is inspected for any abnormalities and completeness of removal of contents
Green Armytage haemostatic clamps are applied to the angles and the margins of the uterine incision to achieve control of bleeding
The uterine incision is closed in a single layer with chromic catgut No: 1 or No: 2 using a interlocking running suture to achieve haemostaisis
It is not necessary to close the visceral and parietal peritoneal layers
Peritoneal toilet is done and the abdomen is closed in layers.

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POST OPERATIVE CARE
Nil orally for 24hrs
Crystalloids for 24 hrs (appx 2500ml)
Antibiotics

as per hospital policy
Pain relief
Care of the bladder
Monitor
Vital parameters
Vaginal bleeding
Urine output
Hydration

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POST OPERATIVE CARE
Palpate the uterine fundus
Location
Consistency
Encourage early breast feeding
Oral fluids

after 24 hrs
Discharge from hospital after 96 hrs
Stitch removal on 7th post operative day
To avoid exertion for 4 – 6 weeks
Contraceptive advice

Caesarean section

Содержание

CAESAREAN SECTIONIt is an operative procedure to deliver the fetus through

CAESAREAN SECTIONINDICATIONSCephalo-pelvic disproportionFetal malpresentationsPrevious caesarean sectionFetal distressPlacenta praeviaAbruptio placentae (with live

CAESAREAN SECTIONINDICATIONSFailed induction Premature rupture of membranesPost datismPre eclampsiaGestational Diabetes mellitusIntra

CAESAREAN SECTIONINDICATIONSVaginal delivery contraindicatedPrevious classical Caesarean section / uterine scar in

CAESAREAN SECTIONCommon indicationsPrevious CaesareanLabour dystociaFetal distressCephalopelvic disproportionMalpresentations ( esp. Breech)Failure of

CAESAREAN SECTIONIncidence - Varies from 15% to 30%Rise in incidence is due toIncreased

CAESAREAN SECTIONContraindications : Valid in the absence of maternal indications of

TIMING OF CAESAREAN SECTIONELECTIVEWhen the caesarean section is done as a

LOWER SEGMENT CAESAREAN SECTIONPreoperative actionsValid informed consentInj Ranitidine 50 mg IV

LOWER SEGMENT CAESAREAN SECTIONANAESTHESIASpinalEpiduralGAPOSITIONDorsal position15 degree lateral tilt to prevent

LOWER SEGMENT CAESAREAN SECTIONAbdominal cleaning and drapingAbdominal incisionTransverse ( Pfannensteil /

LOWER SEGMENT CAESAREAN SECTIONUterine incisionLower segment transverseApposition betterLesser bleeding due to

CLASSICAL CAESAREAN SECTIONINDICATIONSAccess to lower uterine segment is restricted because of

LOWER SEGMENT CAESAREAN SECTIONDoyen’s retractor is introduced in the lower part

LOWER SEGMENT CAESAREAN SECTIONThe presenting part is hooked by the operator

POST OPERATIVE CARENil orally for 24hrsCrystalloids for 24 hrs (appx 2500ml)Antibiotics

POST OPERATIVE CAREPalpate the uterine fundusLocation ConsistencyEncourage early breast feedingOral fluids

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