This document discusses caesarean section, including its definition as delivery of the fetus through abdominal and uterine incisions after fetal viability. It provides caesarean section rates ranging from 5% to 40% in different countries. The main indications for caesarean section are labor abnormalities related to the passage or passenger, as well as pregnancy diseases. There are two main types - classical involving a vertical uterine incision, and lower segment involving a transverse incision. Complications can occur during or after the operation and include hemorrhage, infection, and wound issues.

1. CAESAREAN SECTION

2. DEFINITION
Delivery of the fetus through an
abdominal and uterine incision after
age of fetal viability
( before age of fetal viability it is
termed Hysterotomy )

3. Rate of cesarean section
 The caesarean section rate range from 5%
in Bolivia to as high as 40% in Chile
 WHO rate 15%
 At UTH the caesarean section rate was at
18% in 2005
 The overall caesarean section rate in
Zambia is 2%

4. Indications
LABOUR ABNORMALITIES
1. PASSAGE
A) Contracted pelvis and fetomaternal
disproportion
B) Soft tissues obstruction

5. Indications
2. PASSENGER
- Large fetus
- Certain cases of malpresentation
- Fetal distress
- Prolapsed pulsating cord before the cervix
fully dilated
- Repeated IUFD in the last weeks of
pregnancy
-

6.  POWER :
abnormal uterine action e. g.
retraction ring
Cervical dystocia
 Pregnancy diseases
- Placenta previa
- Certain cases of medical diseases
with pregnancy
- Certain cases of polyhydramnios
- Infection of the genital tract with
herpes
to prevent infection of the
newborn
- PMTCT

7.  Previous operations
- Previous hysterotomy
- Previous caesarean section if :
Contracted pelvis
2 or more caesarean sections
H/o of classical caesarean section

8. Historical aspects
 Sanger 1882 Uterine closure
 B.Kronig 1912 Low vertical
 Munroe Kerr 1926 low
transverse
incision

9. Types of cesarean section
 Classical C.S. means a longitudinal
incision
of upper uterine segment
 Lower segment section

10. CLASSICAL CAESAREAN SECTION
1. Abdominal incision
2. Uterine incision 10cm midline vertically
in the the upper uterine segment
3. Extraction of the fetus
4. Uterine wound repair ( 3 layers )
5. Abdominal repair

11. Indications for the classical caesarean
section
 Structutal abnormality makes lower
segment approach difficult
 Transverse lie of the fetus with neglected
shoulder
 Fibroids in lower segment
 Varicose veins in lower uterine segment
 Postmortem caesarean section

12. ADVANTAGES OF LOWER SEGMENT
C/S
 Blood loss less because LUS thin and less
vascular
 Postoperative ileus and intestinal obstruction
due to postoperative adhesions are less frequent
 Scar rupture in subsequent pregnancy is less
Lower segment is passive during labour
Better coaptation of the wound

13. COMPLICATIONS OF CAESAREAN
SECTION
DURING OPERATION
- Shock
- Haemorrhage due to injury of uterine
vessels, atony of the uterus
and coagulation defects as in case of
abruptio placentae
- Anaesthetic complications

14. POSTOPERATIVE COMPLICATIONS
 Pulmonary embolism , DVT
 Pneumonia
 Endometritis
 Peritonitis
 Paralytic ileus
 Wound infection
 Wound dehiscence and rupture of uterine
scar in subsequent pregnancy or labour