Helpful for learning abortion

1. Prepared by Nurzhan Musaeva
CESAREAN SECTION
C-SECTION

2. Definition: c-section is the delivery of a
baby through a surgical incision in the
abdomen and uterus.

3. 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

4. INDICATIONS:
• Previous caesarian section
• Dystocia or dysfunctional labour
• Fetal distress
• Breech presentation
• Placental abruption
• Placenta previa
• Cord prolapse and etc.

5. CLASSIFICATION
1. ELECTIVE
2. EMERGENCY
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6. CLASSIFICATION
Category Description
1
Immediate threat to the life of the woman or
fetus
2
Maternal or fetal compromise that is not
immediately life-threatening
3
No maternal or fetal compromise but needs
early delivery
4 Elective – delivery timed to suit woman or staff

7. Hysterotomy - surgical incision of the uterus
CLASSIFICATION
1. PRIMARY - first-time hysterotomy
2. SECONDARY - surgery on the uterus with one or more prior hysterotomy incisions

8. Anesthesia
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The majority of Caesarean sections are
performed under regional
anaesthetic – this is usually an ‘topped-
up’ epidural or a spinal anaesthetic.
Sometimes a general anaesthetic is
required. The can be because of a
maternal contraindication to regional
anaesthetic, failure of reginal anaesthesia
to achieve the required block, or more
commonly because of concerns about
fetal wellbeing and the need to expedite
delivery as soon as possible

9. Timing of scheduled Cesarean
Delivery
Adverse neonatal outcomes from neonatal immaturity with elective
delivery before 39 completed weeks are appreciable. To avoid this,
elective c-sections performed after 39 completed weeks.
In case of emergency c-sections before 39 weeks of gestation, we
do corticosteroid therapy (48 hours) for fetus lung maturation.

10. • Sedative can be given at bedtime
the night before surgery
• Oral intake stopped at least 8
hours before the procedure
• Infection prevention. Proved that
single dose of antimicrobial agent
given during 60 min before start of
Cesarean delivery significantly
decreases infection morbidity. (1gr
cefazolin, 2 gr for obese women)
Perioperative care
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11. BY SURGICAL
TECHNIQUE
The classical caesarean section
• It involves a midline longitudinal incision
which allows a larger space to deliver baby.
• It is rarely performed today, as it is more
prone to complications.
The lower uterine segment caesarean section
• This is most commonly used today
• It involves a transverse cut above the edge
of the ladder
• It results in less blood loss and is easier to
repair.

13. Technique for
cesarean delivery
Abdominal incision can be:
1. Midline vertical
2. Suprapubic transverse
(Pfannenstiel, more often,
because of decreased rates
of postoperative pain, fascial
wound dehiscence and
incisional hernia compared
to with vertical entry)

14. • Most practitioners use the traditional Pfannenstiel incision.
•Recent data suggests lower rates of complication with the Joel- Cohen incision, a straight
lateral incision about two centimetres above the Pfannenstiel location.
•Pfannenstiel skin incision • is slightly curved, 2-3 cm or 2 fingers above the symphysis
pubis, with the midportion of the incision within the shaved area of the pubic hair;
•Joel-Cohen incision • is straight, 3 cm below the line that joins the anterior superior iliac
spines, slightly more cephalad than Pfannenstiel
• There are good data suggesting that there are benefits from using the Joel-Cohen,
including • shorter length of maternal stay, • less febrile morbidity, less pain medication
use, • shorter time to delivery and • less operating room time overall. • It is designed for
less tissue dissection and disruption
SKIN INCISION

15. DISSECTION OF
FASCIA OFF THE
RECTUS
MUSCLES
Data strongly supports the use of blunt
dissection using the fingers instead of
scissors or other sharp instruments.

16. EXPANSION
OF UTERINE
INCISION
Blunt expansion
remains preferred to
sharp expansion of the
uterine incision • It is
associated with
decreased maternal
morbidity as measured
by estimated blood loss
and decrease in
haemoglobin

18. PLACENTAL
REMOVAL
Manual extraction of the placenta is
indicated
• It is another traditional technique that’s
changing.
• Studies / trials show lower rates of
endometritis with manual extraction
compared to spontaneous extraction.

19. UTERINE
INCISION REPAIR
• Closure of the uterine incision with
single- vs double-layer closure
• The data on uterine incision repair
and subsequent uterine rupture are
unclear.
• Some data suggest that single layer
repair is associated with a greater
risk of rupture.
• Other studies suggest that a locked
stitch is more likely to result in
future uterine rupture than an
unlocked stitch.

20. PERITONEAL
CLOSURE
Peritoneal closure is similarly mixed.
• Closing the parietal peritoneum is
associated with fewer adhesions of fascia
to the uterus, omentum to uterus, and
omentum to fascia.
• There are also benefits to not closing the
visceral peritoneum, including decreased
inflammation, urge incontinence, and
urinary frequency.

21. Aponeurosis repair

22. • SKIN CLOSURE
• SUBCUTANEOUS TISSUE MANAGEMENT•
Subcutaneous tissue management: • It changes with
depth. • There are no advantages to closing
subcutaneous tissues less than two centimetres
deep and • There are advantages to closing tissues
deeper than two centimetres. • Adhesion barriers
generally provide no benefit
• SKIN CLOSURE • The data are clear when it comes
to skin closure. • Sutures have fewer complications
than staples, • Subcuticular sutures have the lowest
rates of wound separation.
• SUBCUTANEOUS
TISSUE
MANAGEMENT