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Caesarean section by UM


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Caesarean section by UM

  2. 2. Definition <ul><li>delivery of a fetus by incision through the abdominal wall and uterus </li></ul>
  3. 3. Types of Caesarean Section LSCS (Lower segment Caesarean section) Upper segment / Classical Caesarean section <ul><li>Transverse incision over the lower segment of the uterus </li></ul><ul><li>Relatively avascular </li></ul><ul><li>Does not take an active part in contraction and retraction during labour </li></ul><ul><li>Access to the presenting part of the fetus </li></ul><ul><li>Encourages good healing </li></ul><ul><li>Vertical incision over the fundus and body of the uterus </li></ul><ul><li>More vascular </li></ul><ul><li>Takes an active part in contraction and retraction during labor </li></ul><ul><li>Does not give access to the presenting part </li></ul><ul><li>Poor healing </li></ul>
  4. 4. Emergency Lower Segment Caesarean Section <ul><li>Indications : </li></ul><ul><ul><li>Fetal distress </li></ul></ul><ul><ul><li>CPD </li></ul></ul><ul><ul><li>Umbilical cord prolapse </li></ul></ul><ul><ul><li>Placenta abruptio </li></ul></ul><ul><ul><li>Placenta praevia </li></ul></ul><ul><ul><li>Failed instrumental delivery </li></ul></ul><ul><ul><li>Failed IOL </li></ul></ul>
  5. 5. Elective Lower Segment Caesarean Section <ul><li>Indications : </li></ul><ul><ul><li>2 / > previous Caesarean sections </li></ul></ul><ul><ul><li>A previous classical Caesarean section </li></ul></ul><ul><ul><li>CPD </li></ul></ul><ul><ul><li>Placenta praevia </li></ul></ul><ul><ul><li>Breech presentation </li></ul></ul><ul><ul><li>Multiple pregnancy </li></ul></ul><ul><ul><li>IUGR </li></ul></ul><ul><ul><li>Tumours </li></ul></ul>
  6. 6. Upper Segment Caesarean Section <ul><li>avoided unless.. </li></ul><ul><li>Indications : </li></ul><ul><ul><li>Inaccessible lower segment(fibroids) </li></ul></ul><ul><ul><li>Impacted transverse lie </li></ul></ul><ul><ul><li>Major placenta praevia </li></ul></ul><ul><ul><li>Ca of cervix (prior to performing radical hysterectomy) </li></ul></ul><ul><ul><li>Post-mortem Caesarean section </li></ul></ul>
  7. 7. Procedure <ul><li>Anesthesia </li></ul><ul><li>Abdominal incision </li></ul><ul><li>Uterine incision </li></ul><ul><li>Amniotic sac incision </li></ul><ul><li>Delivery of baby </li></ul><ul><li>Umbilical cord clamped </li></ul><ul><li>Delivery of placenta </li></ul><ul><li>Stiching of uterus </li></ul>
  8. 8. <ul><li>Anesthesia </li></ul><ul><li>Elective </li></ul><ul><ul><li>-regional anesthetics (spinal/epidural) </li></ul></ul><ul><ul><li>-numbs only the lower portion of the body </li></ul></ul><ul><li>Emergency </li></ul><ul><li>- Spinal/GA </li></ul><ul><li>- effect faster </li></ul>1. Anaesthesia
  9. 9. 2. Abdominal Incision <ul><li>Elective </li></ul><ul><ul><li>Horizontal/transverse/ Pfannenstiel incision across the abdomen, just above the pubic area. </li></ul></ul><ul><li>Emergency </li></ul><ul><ul><li>prefer a vertical cut, from below the navel to just above the pubic area. </li></ul></ul>Transverse (Pfannenstiel) Vertical <ul><li>More popular </li></ul><ul><li>Limited exposure </li></ul><ul><li>Hernia less common </li></ul><ul><li>Less popular </li></ul><ul><li>Rapid entry and good exposure </li></ul><ul><li>Hernia more common </li></ul>
  10. 10. 3. Uterine incision <ul><li>The sheath, then muscles of the uterus are separated, producing a hole for the delivery of the baby. </li></ul><ul><li>The incision can be either vertical incision or horizontal incision. </li></ul>
  11. 11. 4. Amniotic sac incision <ul><li>Cutting through the amniotic sac </li></ul><ul><li>The amniotic fluid is allowed to escape </li></ul>
  12. 12. 5. Delivery of baby <ul><li>Delivery of baby </li></ul><ul><li>With one hand, the surgeon reaches into the uterus and lifts the baby's head. </li></ul><ul><li>An assistant pushes down on the mother's upper uterus to help guide the baby out </li></ul>
  13. 13. 6. Umbilical cord clamped and cut
  14. 14. 7. Delivery of placenta <ul><li>Delivery of placenta </li></ul><ul><ul><li>controlled cord traction </li></ul></ul>
  15. 15. 8. Stitching <ul><li>uterus is stitched closed (with dissolvable stitches), </li></ul><ul><li>inspect the ovaries and tubes, </li></ul><ul><li>then close the different tissue layers and put staples or stitches into the skin. </li></ul><ul><li>Stitch 3 layers for upper segment (thicker) and 2 layers for lower segment. </li></ul>
  16. 16. Complications <ul><li>MATERNAL </li></ul><ul><li>Infection. (genital tract, UTI, wound) </li></ul><ul><li>Bleeding. </li></ul><ul><li>Injury to bladder and bowel. </li></ul><ul><li>Anesthesia complication. </li></ul><ul><li>Thromboembolism. </li></ul><ul><li>Next delivery </li></ul><ul><li>Uterine rupture </li></ul><ul><li>Placenta previa </li></ul><ul><li>Placenta accreta </li></ul>
  17. 17. Complications <ul><li>BABY </li></ul><ul><li>Premature birth. </li></ul><ul><li>Breathing problems. </li></ul><ul><li>Low Apgar scores. </li></ul><ul><li>Fetal injury. </li></ul>
  18. 18. Advantages <ul><li>MATERNAL </li></ul><ul><li>-Reduced uterovaginal prolapse </li></ul><ul><li>-Reduced urinary incontinence </li></ul>
  19. 19. THANK YOU