Caesarean section
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  • 2. • It is an operative procedure whereby the fetuses after the end of 28 th week are delivered through an incision on the abdominal and uterine walls. • The first operation performed on a patient is referred to as primary caesarean section • When the operation is performed in subsequent pregnancies ,it is called repeat caesarean section.
  • 3. FACTORS FOR RISING CAESAREAN SECTION RATE • Identification of at risk fetuses before term • Identification of at risk mother • Wider use of repeat cs in cases with previous Caesarean delivery. • Rising rate of induction of labour and failure of induction • Decline in operative vaginal delivery and manipulative vaginal delivery • Delivery in vaginal breech delivery • Increased number of women with age ..>30 and associated medical complication
  • 4. • Caesarean delivery on demand • Increased diagnosis of fetal distress • Fear of litigation in obstetric practice
  • 5. INDICATION • Absolute indication • Vaginal delivery is not possible • Central placenta previa • Contracted pelvis or cephalopelvic disprportion • Pelvic mass • Advanced carcinoma cervix • Relative indication • Cephalopelvic disproprtion • Previous caearean delivery • Nonreassuring FHR • Dystocia may be due to 3p
  • 6. ABSOLUTE • Vaginal obstruction • Common indication –Primi • Multi RELATIVE • Antepartum haemorrhage • Malpresentation • Failed surgical induction of labour • Bad obstetric history • Hypertensive disorders • Medical or gynaecological disorders
  • 7. TIME OF OPERATION • Elective-Prearranged time • Emergency-unforseen or acute obstetric emergencies.
  • 8. TYPES OF OPERATION • Lower segment caesarean section(LSCS)- In this operation, the extraction of baby is done through an incision made in the lower segment through a trans peritoneal approach • Classical-In this operation baby is extracted through an incision made in the upper segment of uterus
  • 9. LSCS • Transverse incision-Advantages;Post operative discomfort is more,Fundus of uterus can be better palpated during immediate postoperative period,Less chance of wound dehiscence,Less chance of incisional hernia,Cosmetic value • Disadvantages----Takes alittle longer time, Blood loss is slightly more,Requires competency during repeat section,Unsuitable for classical operation
  • 10. • Average blood loss ----1/2 to 1 litre
  • 11. LOWER SEGMENT • Technically slight difficult • Blood loss is less • Wall is thin and as such apposition is perfect • Perfect peritonisation is possible • Technical difficulty in placenta praevia or transverse lie. CLASSICAL • Technically easy • Blood loss is more • Wall is thick and apposition of margin is not perfect • Perfect peritonisation not possible • Comparatively safer in such circumstances
  • 12. • Haemorrhage and shock is less • Peritonitis is less • Peritoneal adhesion and intestinal obstruction are less • Convalescence is better • Morbidity and mortality are much lower • More • Chance of peritonitis is more • More because of imperfect peritonisation • Relatively poor • Morbidity and Mortality are high
  • 13. LOWER S EGMENT • Perfect muscle apposition due to thin margins • Minimal wound haematoma • Wound remains quiscent durin g healing process • Chance of gutter formation is unlikely • Scar rupture is less (0.51.5%) CLASSICAL • Imperfect apposition • More wound haematoma formation • Wound is in a state of tension due to contraction and relaxation of the upper segment • Chance of gutter formation on the inner aspect is more • Scar rupture -4-9%
  • 14. MERITS AND DEMERITS LOWER SEGMENT TRANSVERSE • Extension of incision may occur to involve the uterine vessels • Bladder dissection is minimal • Uterine closure –easy • Muscle apposition –good • Reperitonisation –complete • Intra operative bleeding less • Subsequent adhesion -less LOWER SEGMENT vertical • Involve the upper segment or downward the bladder • More when extends inferiorly • Difficult • Imperfect • Imperfect • More • More
  • 15. COMPLICATIONS OF CAESAREAN SECTION • Intra operative complication • Post operative complication