2. TYPES OF CSTYPES OF CS
Lower segment CSLower segment CS
Classical CS (upper segment)Classical CS (upper segment)
Indications for classical incisionIndications for classical incision::
Transverse lie with spontaneous ROMTransverse lie with spontaneous ROM
Structural abnormality that makes lower segmentStructural abnormality that makes lower segment
approach difficultapproach difficult
Constriction ring with neglected labourConstriction ring with neglected labour
Fibroids in the lower segmentFibroids in the lower segment
Abnormally vascular lower segmentAbnormally vascular lower segment
Mother dead & rapid delivery is requiredMother dead & rapid delivery is required
Very preterm fetus in breech presVery preterm fetus in breech pres
3. INDICATIONS FOR ELECTIVE CSINDICATIONS FOR ELECTIVE CS
Known CPDKnown CPD
Fetal macrosomiaFetal macrosomia >>
4500 gm4500 gm
Placenta previaPlacenta previa
VV fistula repairVV fistula repair
HIVHIV
Active herpesActive herpes
Repeat CSRepeat CS
Uterine surgery eg.Uterine surgery eg.
Hystrotomy,Hystrotomy,
myomectomymyomectomy
Severe IUGRSevere IUGR
BreechBreech
Multiple pregnancyMultiple pregnancy
Transverse lieTransverse lie
Ca of the CervixCa of the Cervix
obstructing the birthobstructing the birth
canalcanal
4. INDICATIONS FOR EMERGRENCY CSINDICATIONS FOR EMERGRENCY CS
Severe PETSevere PET
Abruptio placntaeAbruptio placntae
Fetal distressFetal distress
Failure to progress in the first stage of labourFailure to progress in the first stage of labour
Cord prolapseCord prolapse
Obstructed labourObstructed labour
Failed inductionFailed induction
MalpresentationMalpresentation brow, chin post, shoulder &brow, chin post, shoulder &
compound presentations, breechcompound presentations, breech
Compromised fetus related to DM, HTN,Compromised fetus related to DM, HTN,
isoimmunizationisoimmunization
APHAPH
5. TIMING OF ELECTIVE CSTIMING OF ELECTIVE CS
For maternal interestFor maternal interest no choiceno choice
For fetal interestFor fetal interest consider maturity & fetalconsider maturity & fetal
conditioncondition
Usually at 38 wksUsually at 38 wks
6. Before Emergency CSBefore Emergency CS
Explain to the Pt & husband & obtain consentExplain to the Pt & husband & obtain consent
Inform anesthetist, OT staff, pedInform anesthetist, OT staff, ped
100% oxygen mask in case of fetal distress100% oxygen mask in case of fetal distress
Sodium citrate 20 ml , metoclopramide 10 mg IVSodium citrate 20 ml , metoclopramide 10 mg IV
Transfer to the theatre, start IV , take blood for Hb,Transfer to the theatre, start IV , take blood for Hb,
x-match, and arrange 2 U of bloodx-match, and arrange 2 U of blood
Preferable to use spinal or epidural anaethesiaPreferable to use spinal or epidural anaethesia
7. Catheterize the bladderCatheterize the bladder
Prophylactic antibioticsProphylactic antibiotics ↓↓ incidence of infection↓↓ incidence of infection
Inform paediatriciand if the mother had opiates inInform paediatriciand if the mother had opiates in
the last 4 hrsthe last 4 hrs
Halothane should not be usedHalothane should not be used uterine relaxationuterine relaxation
& bleeding& bleeding
8. COMPLICATIONSCOMPLICATIONS
INTRAOPERATIVEINTRAOPERATIVE
Bleeding & the need for bl transfusionBleeding & the need for bl transfusion
HysterectomyHysterectomy
Complications of anaesthesiaComplications of anaesthesia
Damage to the bladder, ureter, colon , retained placentalDamage to the bladder, ureter, colon , retained placental
tissuetissue
Fetal injuryFetal injury
POSTOPERATIVEPOSTOPERATIVE
Gaseous distensionGaseous distension
Paralytic ileusParalytic ileus
Wound dehiscence & infectionWound dehiscence & infection
InfectinsInfectins UTI, pulmonaryUTI, pulmonary
DVT & pulmonary embolismDVT & pulmonary embolism
DeathDeath
Vesico uterine fistulaVesico uterine fistula
9. POSTNATAL CAREPOSTNATAL CARE
V/S & blood loss must be moniteredV/S & blood loss must be monitered
Uterine fundus palpatedUterine fundus palpated
Effective parentral analgesicsEffective parentral analgesics
Deep breathing & coughing encouragedDeep breathing & coughing encouraged
Early mobilizationEarly mobilization
Fluid therapy &dietFluid therapy &diet
Bladder & bowel functionBladder & bowel function
Wound careWound care
LabLab
Breast careBreast care
Prophylaxis for thrombembolismProphylaxis for thrombembolism
10. MODE OF DELIVERY IN NEXTMODE OF DELIVERY IN NEXT
PREGNANCYPREGNANCY
CRITERIA FOR Vaginal DeliveryCRITERIA FOR Vaginal Delivery
Pt must agree to the procedurePt must agree to the procedure
A low transverse uterine incisionA low transverse uterine incision
Non recurrent cause of the previous CSNon recurrent cause of the previous CS
No macrosomia, malposition, multiple gestation,No macrosomia, malposition, multiple gestation,
breechbreech
ContraindicationContraindication
Previous classical CSPrevious classical CS
2 or more previous CS2 or more previous CS
Previous other uterine surgeryPrevious other uterine surgery
History of scar ruptureHistory of scar rupture
Placentaprevia or transverse liePlacentaprevia or transverse lie
11. CONDUCT OF LABOURCONDUCT OF LABOUR
Similar to the conduct of normal labourSimilar to the conduct of normal labour
Observe forObserve for
ProgressProgress
Fetal wellbeingFetal wellbeing
Maternal well beingMaternal well being
Cx may be ripenedCx may be ripened
Labour may be augmentedLabour may be augmented
Epidural & other analgesics may be usedEpidural & other analgesics may be used
HOSPITAL SHOULD PROVIDE BLOOD ,HOSPITAL SHOULD PROVIDE BLOOD ,
OPERATING ROOM 24 HRS, NEONATALOPERATING ROOM 24 HRS, NEONATAL
RESUSCITATION, NURSING, ANAESTHESIARESUSCITATION, NURSING, ANAESTHESIA
&SURGICAL PERSONNEL CAN START CS&SURGICAL PERSONNEL CAN START CS
WITHIN 30 MINWITHIN 30 MIN
12. ABNORMALABNORMAL
LABOUR/DYSTOCIA/FAILURE TOLABOUR/DYSTOCIA/FAILURE TO
PROGRESS IN LABOURPROGRESS IN LABOUR
When there is no progress in labour after 24When there is no progress in labour after 24
hours of true labour painshours of true labour pains
CAUSESCAUSES
1-Abnormalities of the pasage1-Abnormalities of the pasage
Alteration in the shape of the pelvisAlteration in the shape of the pelvis
Mass occupying the birth canalMass occupying the birth canal
CPDCPD
13. ABNORMALABNORMAL
LABOUR/DYSTOCIA/FAILURE TOLABOUR/DYSTOCIA/FAILURE TO
PROGRESS IN LABOURPROGRESS IN LABOUR
2-Abnormalities in the passenger2-Abnormalities in the passenger
Abnormal lieAbnormal lie
Abnormal presentationAbnormal presentation
occiput-postrior, occiput-transverseocciput-postrior, occiput-transverse
browbrow
faceface
breechbreech
Macrosomia , perinatal mortality 5* higher than NMacrosomia , perinatal mortality 5* higher than N
WtWt
Congenital malformationCongenital malformation
Multiple gestationMultiple gestation
14. ABNORMALABNORMAL
LABOUR/DYSTOCIA/FAILURE TOLABOUR/DYSTOCIA/FAILURE TO
PROGRESS IN LABOURPROGRESS IN LABOUR
3-Abnormalities in the powers3-Abnormalities in the powers
Ineffective uterine activityIneffective uterine activity
Lack of voluntary expulsive efforts in the 2Lack of voluntary expulsive efforts in the 2ndnd
stagestage
DYSTOCIA IS THE MOST COMMON INDICATIONDYSTOCIA IS THE MOST COMMON INDICATION
FOR CSFOR CS