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Caesarean section - indications and types


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my ostetrics and gynecology presentation in final year.. 2012...

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Caesarean section - indications and types

  1. 1. Caesarean Section Indications and types VISHNU AMBAREESH M S 2007 BATCH
  2. 2. • According to legend, Julius Caesar was born by this operation and hence the origin of the term caesarean. ???? • Used to be invariably fatal • Most important modification was the lower segment transverse incision. First done by kehrer and popularized by Munro Kerr
  3. 3. DEFINITION • CAESAREAN SECTION is the removal of a child through an incision in the abdominal wall of an intact uterus. • Term not applied to removal of a child from the abdomen after rupture of the uterus with or without protrusion of the whole or part of the child into the peritoneal cavity, nor to an operation for abdominal pregnancy.
  4. 4. INCIDENCE • It is the most commonest operation performed worldwide. • Ideal CS rate is 10 to 15 % (WHO) • Increased incidence worldwide during last 25 years.
  5. 5. Why has the incidence increased? • Mainly due to 3 factors 1. Repeat caesarean 2. Dystocia 3. Fetal distress • Increased safety of the surgery • Increased demand
  6. 6. INDICATIONS • Divided into 1. Maternal indicators 2. Fetal indicators 3. Fetomaternal indicators- coexist
  7. 7. MATERNAL INDICATORS PREVIOUS CS DYSTOCIA due to 1. -CPD 2. -tumours complicating pregnancy 3. -non progressive labour 4. -threatened rupture and obstructed labour 5. -failed forceps or vacuum 6. -deep transverse arrest
  8. 8. Antepartum hemorrhage 1. -placenta praevia 2. -abruptio placenta 3. -vasa praevia 4. -carcinoma cervix Medical disorders 1. -pre-eclampsia and eclampsia 2. -coarctation of aorta
  9. 9. Maternal obstetric problem 1. -elderly nullipara 2. -prolonged period of infertility or pregnancy following IVF 3. -bad obstetric history 4. -previous repair of nulliparous prolapse 5. -stress incontinence or fistula 6. -failed induction
  10. 10. FETAL INDICATION • Fetal distress and cord prolapse • Breech presentation –[footling, knee presentation, complicated breech] • Malpresentation [ brow, transverse lie persistent mentoposterior ] • Sever IUGR • Macrosomia • Multiple pregnancy[first twin non -vertex and monoamniotic twin] • HIV complicating
  12. 12. CAESARAEAN SECTION -TYPES • Lower Segment Caeserean Section(LSCS) • Lower segment vertical incision • Classical CS • Extraperitoneal caeserean • Caeserean hysterectomy
  13. 13. LSCS • Most commonly employed type • Involves lower segment transverse incision
  14. 14. LOWER SEGMENT VERTICAL INCISION Indications: • Constriction ring • Lower segment not formed as in transverse lie Disadvantages: • Extension downwards may involve the cervix,vagina and even the bladder • Extension into the upper segment increases the chance of rupture in next pregnancy
  15. 15. Classical Caesarean section • Lower segment is not approachable • Uterine incision –on the anterior uterine wall in the upper segment above the reflection of the UV fold of peritoneum • Fetal foot grasped and baby delivered as breech
  16. 16. Classical CS - Indications • Lower segment is unapproachable due to severe adhesions or myomas • Ca cervix • Some cases of anterior placenta praevia with a previous caeserean • Some cases of transverse lie with ruptured membranes • Conjoined twins
  17. 17. Classical CS - Disadvantages • Chance of scar rupture more • General peritonitis ,if infection occurs
  18. 18. LSCS SCAR CLASSICAL SCAR Apposition Better Difficult Healing in puerperium Better as the Lower segment is quiscent Imperfect due to contraction and retraction of upper segment Placental implantation May be over the scar much more likely Rupture .5-2% 4-8% Timing of rupture In labour In pregnancy and labour Infection Less chance More chance
  19. 19. Extraperitoneal Caesarean section • In severe infection • Uterus opened through an extraperitoneal approach • Through the space of Retzius beneath the bladder
  20. 20. Caesarean Hysterectomy • Life saving measure for severe atonic PPH Indications • Severe atonic PPH • Placenta accreta , increta, percreta • Severe sepsis • Multiple large myomas • Carcinoma in situ of the cervix
  21. 21. Cesarean section is safe, but it’s not as safe as a planned vaginal delivery • Many pregnant women believe that undergoing a cesarean section is a no risk surgery • They suffer more than three times the number of cardiac arrests, blood clots and major infections than those who deliver vaginally