Caesarean section

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Caesarean section

  1. 1. CAESAREAN SECTION “YET ANOTHER WAY TO GET OUT!”
  2. 2. WHY CALLED SO?? According to legend ,julius caesar was born by this operation It was a fatal operation until beginning of 20th century. Now the most common operation performed worldwide
  3. 3. 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 15- 20%. But in most countries it is 15-20%
  4. 4. 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
  5. 5. INDICATIONS Previous caesarian section Dystocia or dysfunctional labour Fetal distress Breech presentation Antepartum haemorrhage Maternal problems Caesarian section on demand
  6. 6. LSCS
  7. 7. • Cross matched blood• Catheter introduced• Antibiotic prophylaxis• Heparin as thromboprophylaxis• Parts cleansed with antiseptic solution• Left lateral position- reduce aortocaval compression. reduce risk of supine hypotension
  8. 8. ANAESTHESIA• GA or REGIONAL• REGIONAL - Spinal or Epidural• Mendelson’s syndrome- GA given as emergency- risk of aspiration- chemical pneumonitis.• To counteract- antacids given during labour, oral fluids withheld• 30 ml 0.3 molar sodium citrate orally -1/2 hr before surgery.• Sellick’s manoeuvre- endotracheal intubation accompained by pressure on
  9. 9. ABDOMINAL INCISIONSPfannensteil incision-MC used. Transverse curvilinear incision above pubic hairline Deepened through s/c tissue upto rectus sheath Rectus sheath divided transversely
  10. 10. Maylard incision Option when more exposure is needed in transverse incision Recti muscles are dividedMidline vertical incision
  11. 11. Transverse Vertical incision incisionCosmetic appeal More LessPostoperative pain Less MoreWound dehiscence Less MoreIncisional hernia Less MoreTechnical skill More LessTime taken More LessAccess to upper Less Good, can beabdomen extended
  12. 12. PROCEDURE• Once abdomen opened- dextrorotation of uterus corrected• Doyen retractor- visualize lower segment• Peritoneum over lower segment identified- divided transversely- seperated from bladder by blunt dissection• Small incision in lower segment-extended laterally• Inadequate space- J shaped or inverted T incision• Do not injure uterine vessels lying laterally
  13. 13. DELIVERY OF BABYCephalic presentation Hand slipped into uterine cavity Head is levered out gently Floating head- use forceps to deliver the baby. Breech presentation feet hooked out first rest delivered as vaginal breech delivery
  14. 14. Transverse or oblique lie corrected to longitudinal lie before making uterine incision.Transverse lie with ruptured membranes & undeveloped lower segment extension of uterine incision required
  15. 15. CLOSURE OF UTERINE INCISION OXYTOCIN infusion started as soon as baby is delivered Uterine fundus contracts-placenta and membranes extrudes spontaneously- removed Wipe with moist pad- ensure uterine cavity is empty and cervical canal is open Uterine edges- held with ALLIS forceps or GREEN ARMYTAGE forceps- incision closed in 2 layers- continuous sutures
  16. 16. Chromic catgut or polyglactin usedAny bleeding points- controlled with figure- of-eight sutures
  17. 17. CLOSURE OF ABDOMEN• PERITONEUM- closed or not closed• RECTUS SHEATH-non absorbable sutures- proline- to reduce wound dehiscence & incisional hernia• SUBCUTANEOUS TISSUE-closed• SKIN- mattress sutures of silk, subcuticcular suture or clips
  18. 18. POST OPERATIVE CARE
  19. 19.  Close monitoring for 1st 6-8 hrs Parenteral fluids Blood transfusion if needed Analgesics and sedatives Oral fluids Early ambulation and deep breathing exercises Light solid diet n laxatives Discharged –day following suture removal/if transverse or subcuticular-5th/6th day
  20. 20. ADVANTAGES OF LSCS Healing better Scar rupture minimal
  21. 21. OTHER TYPES OF CS 1. Low segment vertical incision 2.Classical CS 3.Extra peritoneal CS 4.Caesarean hysterectomy
  22. 22. LOWER SEGMENT VERTICAL INCISION Indications:Constriction ring,lower segment not formed Disadv: injury to cervix, vagina,bladder increased chance of rupture in next pregnancy
  23. 23. CLASSICAL CAESAREANIndicationslower segment unapproachableCA cervixAnterior placenta praevia with prev caesarianTransverse lie with ruptured membranesConjoint twinsDisadvantagesDifficult healingScar ruptureGeneral peritonitis
  24. 24. EXTRAPERITONIAL CAESAREAN Severe infection Extraperitoneal approach Space of Retzius
  25. 25. CAESAREAN HYSTERECTOMYIndicationsSevere atonic PPHPlacenta accreta,increta,percretaSepsisMultiple large myomasCA cervix
  26. 26. COMPLICATIONS OF CAESAREAN SECTION
  27. 27. INTRAOPERATIVE COMPLICATIONS  Primary haemorrhage Injury to internal organs Injury to the baby Difficulty in delivery of the head Anaesthetic complications
  28. 28. PRIMARY HAEMORRHAGE Atonic- oxytocin 20units in 500ml ergometrine0.25mg im or iv prostaglandin F2 alpha 250micgram im and intramurally PGE1 200micgram rectally Traumatic-ligation of concerned vessels Placenta accreta
  29. 29. POSTOPERATIVE COMPLICATIONS Paralytic ileus Respiratory complications Infections Peritonitis Pelvic abscess Pelvic thrombophlebitis Deep vein thrombosis and pulmonary embolism Wound dehiscence
  30. 30. LATE SEQUELAE Secondary PPH Incisional hernia Scar endometriosis Vesico-vaginal fistula Scar rupture in the next pregnancy Placenta praevia and placenta accreta Bladder injury

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