3. DEFINITION
It is an operative procedure whereby the
fetuses after the end of 28th week are
delivered through an incision on the
abdominal and uterine walls.
4. INCIDENCE
• The incidence of cesarean section is
steadily rising
• C-section rate in India – 17.2% was
higher than the WHO-recommended limit
5. INCIDENCE
• Kerala 35.8 to38.9% from 2015-16 to
2019-20
• Urban-Rural difference of caesarean
section deliveries in 2019-20 is 39.1 &
38.7 respectively
7. ABSOLUTE INDICATIONS
Vaginal delivery is not possible.
Central placenta previa
Contracted pelvis
Pelvic mass causing obstruction
Advanced carcinoma cervix
Vaginal obstruction
8. RELATIVE INDICATIONS
Vaginal delivery is possible but risks to
the mother and/ or to the baby are high
Cephalopelvic disproportion
Previous cesarean delivery
10. RELATIVE INDICATIONS
Failed surgical induction of labor, Failure
to progress in labor
Bad obstetric history
Hypertensive disorders
Medical-gynecological disorders
17. EMERGENCY
When the operation is performed due to
obstetric emergencies. An arbitary time limit
of 30 minutes is thought to be reasonable from
the time of decision to the start of the
procedure.
19. UPPER SEGMENT CS
• Also called Classical C.S.
• In this operation, the baby is extracted
through an incision made in the upper
segment of the uterus.
20. LOWER SEGMENT CS
• Also called LSCS
• In this operation, the extraction of the
baby is done through an incision made in
the lower segment through a trans
peritoneal approach.
26. EXTRAPERITONEAL
• The peritoneal cavity is not opened and
the lower uterine segment is reached
either laterally or inferiorly by vesico-
uterine pouch .
• It is indicated in case of chorioamnionitis
34. INCISION ON THE ABDOMEN
• Vertical or a Transverse skin incision.
• Vertical incision – Infraumbilical midline
or paramedian.
• Transverse incision, modified
Pfannenstiel is made 3 cm above the
symphysis pubis.
36. PACKING
• The Doyen’s Retractor is introduced.
• The peritoneal cavity is now packed off using
two taped large swabs.
• The tape ends are attached to artery forceps.
• This will minimize spilling of the uterine
contents into the general peritoneal cavity.
37. UTERINE INCISION
A. Lower segments transverse
B. Lower segment vertical
C. J incision
D. Classical incision
E. Inverted T incision
39. SUTURING
• A continuous suture is placed with chromic
catgut No‘0’ or Vicryl taking deep muscles
excluding the decidua.
• A second layer of interrupted sutures(1cm apart)
using chromic catgut No.1 or Vicryl taking the
entire depth of superficial muscles down to the
first layer of suture.
40. SUTURING
• The third layer of continuous suture
taking the peritoneum with the adjacent
muscles using chromic catgut No ‘0’ and
round bodied needle.
• Then abdomen sutured in layers
41. POSTOPERATIVE CARE
First 24 hours: (Day 0)
• Preparation of post op bed
• Observation
• Fluid – IVF and Blood Transfusion
44. POSTOPERATIVE CARE
Day 2
• Light solid diet
• Bowel care - Laxatives is given at bed
time if the bowels do not move
spontaneously.
45. POSTOPERATIVE CARE
Day 5 or Day 6
• The abdominal skin stitches are to be
removed on the D-5 (in transverse) or
D-6 (in longitudinal).
• Discharge on Day 7
