c-section. indications, contraindications, types, technique, incidents, compications, pre and post-op care.

1. CAESAREAN SECTION
Submitted by-
Snehal kapadiya
II year M.Sc Nursing
Shri Anand college of Nursing
Rajkot

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

3.  INDICATIONS
 Cephalo-pelvic disproportion

4.  Fetal malpresentations

5.  Previous caesarean section
 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 upper segment
 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 Caesarean sections
 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 labour pains:
 Emergency C.S.:
-Done after the start of labour pains.
 According to gestational age:
– Before the age of viability: Hysterotomy.
– After the age of viability: cesarean section.

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
 15 degree 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 24 hrs (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