c-section

1. CAESAREAN SECTION
Prepared By : Syed Hassnain
Shah
Group # 02
Semester # 07
Submitted to : Dr. Kahkashan

2. Definition: It is an operative
procedure to deliver the fetus
through an abdominal and
uterine incision, after the
period of viability.
Itis one of the most commonly
done operations worldwide.

3. INDICATIONS
Cephalo-pelvic disproportion

4. Fetal malpresentations

5. Previous caesareansection
Fetal distress
Placenta praevia

6. Abruptio placentae (with live fetus)

7. Dystocia (Ineffective or prolonged labour)

8. Cord prolapse

9. Failed trial of Forceps / Vacuum delivery

10. High order multifetal gestation

11. -INDICATIONS
Failed induction
Premature rupture of membranes
Post datism
Pre eclampsia
Gestational Diabetes mellitus
Intra uterine growth restriction
Previous unexplained IUFD

12. -INDICATIONS
Vaginal delivery contraindicated
Previous classical Caesarean section / uterine scar
in uppersegment
Contracted pelvis
Placenta praevia
Cord presentation
Fetal compromise
Pregnancy with Carcinoma cervix
Ovarian tumor causing obstruction
Genital tract malformations of the cervix / vagina

13. Common indications
Previous Caesarean
Labour dystocia
Fetal distress
Cephalopelvic disproportion
Malpresentations ( eg. Breech)
Failure of induction
Antepartum haemorrhage

14. Incidence - Varies from 15%to 30%
Rise in incidence is due to:
Increased safety of the procedure
Older / Infertile / High risk women are having
children
Previous Caesareansections
Increased detection of fetal distress
Decrease in difficult operative vaginal deliveries
Improving socio economic status

15. Contraindications :
Maternal indications of abdominal delivery
Intrauterine fetal death
Gross congenital malformations
Extreme prematurity
Coagulation defect

16. According to timing:
Elective C.S. :
-Done before the start of labourpains:
Emergency C.S.:
-Done after the start of labourpains.
According to gestational age:
– Before the age of viability:Hysterotomy.
– After the age of viability: cesareansection.

17. According to uterine incision:
* LOWER SEGMENT C-SECTION:
– Transverse LSCS
– Vertical LSCS
*UPPER SEGMENT C.S (classical cut)

19. Preoperative actions
Valid informed consent
Inj Ranitidine 50 mg IV half to one hour before
the procedure
Inj Metoclopramide 10 mg IV half to one hour
before the procedure
Stomach should be empty
Bladder should be catheterized
Fetal presentation, position and FHS should be
checked

20. ANAESTHESIA
Spinal
Epidural
POSITION
Dorsal position
15degree lateral tilt to prevent supine
hypotension

21. Abdominal cleaning and draping
Abdominal incision
- Transverse
Post op pain is less
Less chance of wound dehiscence / incisional
hernia
Cosmetically better
Rapid entry into abdomen
Capable of extention
Blood loss minimal

22. Uterine incision
-Lower segment transverse
Lesser bleeding due to less vascularity
Less active uterine segment
Healing better
Stretch during subsequent pregnancy is along the
line of incision
Chances of rupture during subsequent pregnancy
/ labour are less

23. - Classical ( Upper segment vertical )
Delivery of baby and placenta.
Suturing
Dressing

27. Post-operative care
Nil orally for 24hrs
Crystalloids for 24hrs (appx 2500ml)
Antibiotics as per hospital policy
Pain relief
Care of the bladder
Monitor
-Vital parameters
- Vaginal bleeding
- Urine output
- Hydration

28. Palpate the uterine fundus
- Location
- Consistency
Encourage early breast feeding
 Oral fluids after 24 hrs
 Discharge from hospital after 96 hrs
 Stitch removal on 7th post operative day
To avoid exertion for 4 – 6 weeks
 Contraceptive advice

29. Primary haemorrhage
Injury to internal organs
Injury to the baby
Difficulty in delivery of head
Anaesthetic complications

30. Haemorrhage
Sepsis
Anaesthetic complications
Thrombo –embolism
Wound complications
Late Incision hernia
Problems in future pregnancies
Scar rupture
Repeat caesarean
Peritonitis
Infections
Pelvic abscess

31. Tubectomy
Hysterectomy
Intrauterine device insertion
Oophorectomy