A slide regarding Caesarean , its types, complication and post op care

1. CAESAREAN SECTION
ASWANI.N

2. • Delivery of viable fetus through an incision in the
abdominal wall and intact uterus
• Primary caesarian – First caesarian section done on a
patient
• Secondary caesarian – Repeat procedure

3. 1. Previous caesarean section
2 Dystocia or dysfunctional labour (abnormalities of powers, passage and
passenger)
• Cephalopelvic disproportion
• Tumours complicating pregnancy
• Fetal macrosomia
• Malpresentations like brow and transverse lie and persistent
mentoposterior
• Deep transverse arrest
• Abnormal uterine action
• Threatened rupture and obstructed labour
• Failed forceps or vacuum

4. 3. Failed induction
4. Fetal distress and cord prolapse
5. Breech presentation (selected cases)
6. Other fetal indications
• Severe intrauterine growth restriction
• Multiple pregnancy (first twin nonvertex and
monoamniotic twins)

5. 7. Antepartum haemorrhage
• Placenta praevia
• Abruptio placenta (live fetus at term or failure to respond to amniotomy and
oxytocin)
• Vasa praevia
8. Maternal problems
• Elderly nullipara
• Prolonged period of infertility or pregnancy following in vitro fertilisation
• Bad obstetric history .
• Previous repair of nulliparous prolapse, stress incontinence or fistula
• HIV complicating pregnancy
9. On maternal request

6. LOWER SEGMENT CAESARIAN
• Cross matched blood should be available
• Indwelling catheter introduced
• Parts cleansed and draped
• Antibiotic prophylaxis given to prevent peuperal sepsis
• Thrombo prophylaxis in patients who have high risk for
DVT
• Paediatrician skilled in neonatal resuscitation should be
available.

7. LOWER SEGMENT CAESARIAN SECTION
Regional(epidural or spinal),general can be
used. In general anesthesia there is chance of mendelson
syndrome.
Tilting the patient 15° to the left in dorsal position
minimise aortocaval compression.
1.Pfannensteil incision: Most commonly used.
Transverse curvilinear incision just above pubic hairline.This is
then deepened down through the subcutaneous fat upto rectus
sheet,which is incised transversely.After separating two recti
muscle in midline,parietal peritoneum is opened.

8. • 2.Joel Cohen incision:modified transverse incision
placed about 3 cm below the line joining the 1 anterior
superior iliac spines.
• incision is higher than pfannelsteil incision and is not
curved
• Sharp dissection is minimised. The recti muscles are
separated by fingert traction. The rectus sheath may be
incised in the midline and both the fascia and
subcutaneous tissue are stretched by blunt finger
dissection.
• 3.Maylard incision: Recti muscles are divided.

9. • Dextro-rotation of uterus
corrected
• Doyens retraction is used
to visualise the lower
segment
• Small incision is made in
lowersegment and
extended laterally by using
scissors or fingers.

10. • In cephalic presentations the hand is
slipped into the uterine cavity and the head
is gently levered out of the incision
• The assistant may exert fundal pressure
on the fetal buttocks to aid in delivery of
the head.
• The mouth and nostrils are suctioned to
prevent aspiration and the rest of the body
is delivered by gentle traction. The
umbilical cord is doubly clamped and the
baby handed over to a person trained in
neonatal resuscitation

11. • As soon as the baby is delivered, an
oxytocin infusion is started.
• The uterine fundus contracts and the
placenta and membranes are removed
by controlled cord traction.
• Next, the uterine edges are held with
Allis forceps and the uterine incision is
closed in two layers of continuous
sutures

12. • The peritoneal cavity is cleaned and
after confirming mop and instrument
count, the abdominal wall is closed in
layers
• Parietal peritoneum need not be closed
• Rectus sheet closed with non-
absorbable or delayed absorbable
sutures
• Subcutaneous tissue closed if
necessary
• Skin sutured

13. • Close monitoring for the first 6-8 hours by means of –
1.Pulse
2.Blood pressure
3.Respiratory rate
4.Intake output chart
5.Vaginal bleeding
6.Condition of uterus

14. • Parenteral fluids given the first day
• Blood transfusion if excessive bleeding present
• Thromboprophylaxis if indicated,heparin can be
commenced
• Antibiotics may be continued post-op
• Oral fluids can be started after 6hours if there is no
vomiting
• Breast feeding can be initiated after 4 hours of surgery
• Urinary catheter can be removed the next day
• Dressing can be removed after 24-48 hours

15. • Early ambulation and deep breathing exercises are
necessary and started the next day
• Light solid diet started on third day.Laxatives given if
bowel movements not initiated
• Incision inspected each day for signs of infection
• If nonabsorbable sutures had been used for the skin,
• the patient can be discharged the day following sture
removal. If the skin incision is transverse and subcuticular
sutures are used, the patient can be discharged on the
5th day.

16. COMPLICATIONS
• INTRAOPERATIVE COMPLICATIONS:
1.Primary haemorrhage
2.Injury to internal organs
3.Injury to baby
4.Difficulty in delivery of head
5.Anaesthetic complication
Aspiration
Mendelsons syndrome
Hypotension
Cardiac arrest

17. • POST-OPERATIVE COMPLICATIONS:
• Paralytic ileus
• Respiratoryy complications .
• Infection, peritonitis and pelvic abscess
• Pelvic thrombophlebitis
• Deep vein thrombosis and pulmonary embolism
• Wound dehiscence

18. • LATE SEQUELE:
• Secondary postpartum haemorrhage
• Incisional hernia
• Scar endometriosis
• Vesicovaginal fistula
• Scar rupture in the next pregnancy
• Placenta praevia and adherent placenta in nex pregnancy
• Vesicovaginal fistula
• Increased incidence of bladder injury at a repeat caesarean or at hysterectomy
later on

19. OTHER TYPES OF CAESAREAN SECTION
• Lower segment vertical
incision
• Classical caesarean
section
• Extraperitonial Caesarean
section
• Caesarean hysterectomy
• Perimortem caesarean
section

20. THANK YOU