Medicine

1. OBSTETRIC PROCEDURES
CAESARIAN SECTION

2. Definition
 Delivery of a fetus through an abdominal
incision
 Hysterotomy when the fetus has not reached
viability for extra-uterine life

3. Types of Caesarian section
 Timing
- Elective/Emergency
 Abdominal incision used
- Midline sub-umbilical/Pfannenstiel
 Uterine incision used
- Lower uterine segment – transverse
- Classical

4. Indications
 Maternal
- Previous scars
- Pre-eclampsia/Eclampsia
- Antepartum hemorrhage
- Contracted pelvis
- Bad obstetric history

5. Indications contd.
 Fetal
- Fetal distress (non-reassuring fetal
status)
- Cord prolapse
- Mal-presentations/Mal-positions
- Macrosomia

6. Procedure
 Preparation – positioning, bladder emptying,
cleaning/draping, administration of
anaesthesia.
 Opening the abdomen
 Opening the uterus
 Extracting the baby and placenta
 Closing the uterus, abdomen

7. Procedure contd.
 Swabs/instruments count
 Closing the abdomen
 Dressing the incision site
 VVT
 Reversal of anaesthesia

8. Instruments/equipment
 Forceps – artery/dissecting/Green armitage
 Retractors – Doyens, Morris, Langenberg
 Kidney dishes, gallipots
 Bladder catheter
 Sutures
 Resucsitaire, paediatric nasal catheter,
ambu-bag

9. Complications
 Haemorrhage
 Iatrogenic injuries – infant, gut, bladder,
hips/shoulders, nerve/soft tissues
 Infection
 Burst abdomen
 DVT