This document discusses cesarean section (CS), including types of CS, indications for elective and emergency CS, timing of elective CS, complications, postnatal care, and mode of delivery in subsequent pregnancies. It notes that lower segment CS and classical/upper segment CS are the main types. Indications include fetal malpresentation, failure to progress in labor, and prior uterine surgery. The timing of elective CS is usually 38 weeks. Complications can be intraoperative like bleeding or postoperative like infection. Strict postnatal care including monitoring is important. Vaginal delivery may be possible in subsequent pregnancies if certain criteria are met like a previous low transverse incision and no other risk factors.

1. CESAREANCESAREAN
SECTIONSECTION
JEELANI SAIMA HABEEB
Ph.D NURSING SCHOLAR

2. TYPES OF CSTYPES OF CS
 Lower segment CSLower segment CS
 Classical CS (upper segment)Classical CS (upper segment)
Indications for classical incisionIndications for classical incision::
 Transverse lie with spontaneous ROMTransverse lie with spontaneous ROM
 Structural abnormality that makes lower segmentStructural abnormality that makes lower segment
approach difficultapproach difficult
 Constriction ring with neglected labourConstriction ring with neglected labour
 Fibroids in the lower segmentFibroids in the lower segment
 Abnormally vascular lower segmentAbnormally vascular lower segment
 Mother dead & rapid delivery is requiredMother dead & rapid delivery is required
 Very preterm fetus in breech presVery preterm fetus in breech pres

3. INDICATIONS FOR ELECTIVE CSINDICATIONS FOR ELECTIVE CS
 Known CPDKnown CPD
 Fetal macrosomiaFetal macrosomia >>
4500 gm4500 gm
 Placenta previaPlacenta previa
 VV fistula repairVV fistula repair
 HIVHIV
 Active herpesActive herpes
 Repeat CSRepeat CS
 Uterine surgery eg.Uterine surgery eg.
Hystrotomy,Hystrotomy,
myomectomymyomectomy
 Severe IUGRSevere IUGR
 BreechBreech
 Multiple pregnancyMultiple pregnancy
 Transverse lieTransverse lie
 Ca of the CervixCa of the Cervix
obstructing the birthobstructing the birth
canalcanal

4. INDICATIONS FOR EMERGRENCY CSINDICATIONS FOR EMERGRENCY CS
 Severe PETSevere PET
 Abruptio placntaeAbruptio placntae
 Fetal distressFetal distress
 Failure to progress in the first stage of labourFailure to progress in the first stage of labour
 Cord prolapseCord prolapse
 Obstructed labourObstructed labour
 Failed inductionFailed induction
 MalpresentationMalpresentation  brow, chin post, shoulder &brow, chin post, shoulder &
compound presentations, breechcompound presentations, breech
 Compromised fetus related to DM, HTN,Compromised fetus related to DM, HTN,
isoimmunizationisoimmunization
 APHAPH

5. TIMING OF ELECTIVE CSTIMING OF ELECTIVE CS
 For maternal interestFor maternal interest  no choiceno choice
 For fetal interestFor fetal interest consider maturity & fetalconsider maturity & fetal
conditioncondition
 Usually at 38 wksUsually at 38 wks

6. Before Emergency CSBefore Emergency CS
 Explain to the Pt & husband & obtain consentExplain to the Pt & husband & obtain consent
 Inform anesthetist, OT staff, pedInform anesthetist, OT staff, ped
 100% oxygen mask in case of fetal distress100% oxygen mask in case of fetal distress
 Sodium citrate 20 ml , metoclopramide 10 mg IVSodium citrate 20 ml , metoclopramide 10 mg IV
 Transfer to the theatre, start IV , take blood for Hb,Transfer to the theatre, start IV , take blood for Hb,
x-match, and arrange 2 U of bloodx-match, and arrange 2 U of blood
 Preferable to use spinal or epidural anaethesiaPreferable to use spinal or epidural anaethesia

7.  Catheterize the bladderCatheterize the bladder
 Prophylactic antibioticsProphylactic antibiotics ↓↓ incidence of infection↓↓ incidence of infection
 Inform paediatriciand if the mother had opiates inInform paediatriciand if the mother had opiates in
the last 4 hrsthe last 4 hrs
 Halothane should not be usedHalothane should not be used uterine relaxationuterine relaxation
& bleeding& bleeding

8. COMPLICATIONSCOMPLICATIONS
INTRAOPERATIVEINTRAOPERATIVE
 Bleeding & the need for bl transfusionBleeding & the need for bl transfusion
 HysterectomyHysterectomy
 Complications of anaesthesiaComplications of anaesthesia
 Damage to the bladder, ureter, colon , retained placentalDamage to the bladder, ureter, colon , retained placental
tissuetissue
 Fetal injuryFetal injury
POSTOPERATIVEPOSTOPERATIVE
 Gaseous distensionGaseous distension
 Paralytic ileusParalytic ileus
 Wound dehiscence & infectionWound dehiscence & infection
 InfectinsInfectins  UTI, pulmonaryUTI, pulmonary
 DVT & pulmonary embolismDVT & pulmonary embolism
 DeathDeath
 Vesico uterine fistulaVesico uterine fistula

9. POSTNATAL CAREPOSTNATAL CARE
 V/S & blood loss must be moniteredV/S & blood loss must be monitered
 Uterine fundus palpatedUterine fundus palpated
 Effective parentral analgesicsEffective parentral analgesics
 Deep breathing & coughing encouragedDeep breathing & coughing encouraged
 Early mobilizationEarly mobilization
 Fluid therapy &dietFluid therapy &diet
 Bladder & bowel functionBladder & bowel function
 Wound careWound care
 LabLab
 Breast careBreast care
 Prophylaxis for thrombembolismProphylaxis for thrombembolism

10. MODE OF DELIVERY IN NEXTMODE OF DELIVERY IN NEXT
PREGNANCYPREGNANCY
CRITERIA FOR Vaginal DeliveryCRITERIA FOR Vaginal Delivery
 Pt must agree to the procedurePt must agree to the procedure
 A low transverse uterine incisionA low transverse uterine incision
 Non recurrent cause of the previous CSNon recurrent cause of the previous CS
 No macrosomia, malposition, multiple gestation,No macrosomia, malposition, multiple gestation,
breechbreech
ContraindicationContraindication
 Previous classical CSPrevious classical CS
 2 or more previous CS2 or more previous CS
 Previous other uterine surgeryPrevious other uterine surgery
 History of scar ruptureHistory of scar rupture
 Placentaprevia or transverse liePlacentaprevia or transverse lie

11. CONDUCT OF LABOURCONDUCT OF LABOUR
Similar to the conduct of normal labourSimilar to the conduct of normal labour
Observe forObserve for
 ProgressProgress
 Fetal wellbeingFetal wellbeing
 Maternal well beingMaternal well being
 Cx may be ripenedCx may be ripened
 Labour may be augmentedLabour may be augmented
 Epidural & other analgesics may be usedEpidural & other analgesics may be used
 HOSPITAL SHOULD PROVIDE BLOOD ,HOSPITAL SHOULD PROVIDE BLOOD ,
OPERATING ROOM 24 HRS, NEONATALOPERATING ROOM 24 HRS, NEONATAL
RESUSCITATION, NURSING, ANAESTHESIARESUSCITATION, NURSING, ANAESTHESIA
&SURGICAL PERSONNEL CAN START CS&SURGICAL PERSONNEL CAN START CS
WITHIN 30 MINWITHIN 30 MIN

12. ABNORMALABNORMAL
LABOUR/DYSTOCIA/FAILURE TOLABOUR/DYSTOCIA/FAILURE TO
PROGRESS IN LABOURPROGRESS IN LABOUR
When there is no progress in labour after 24When there is no progress in labour after 24
hours of true labour painshours of true labour pains
CAUSESCAUSES
1-Abnormalities of the pasage1-Abnormalities of the pasage
 Alteration in the shape of the pelvisAlteration in the shape of the pelvis
 Mass occupying the birth canalMass occupying the birth canal
 CPDCPD

13. ABNORMALABNORMAL
LABOUR/DYSTOCIA/FAILURE TOLABOUR/DYSTOCIA/FAILURE TO
PROGRESS IN LABOURPROGRESS IN LABOUR
2-Abnormalities in the passenger2-Abnormalities in the passenger
 Abnormal lieAbnormal lie
 Abnormal presentationAbnormal presentation
 occiput-postrior, occiput-transverseocciput-postrior, occiput-transverse
browbrow
faceface
breechbreech
 Macrosomia , perinatal mortality 5* higher than NMacrosomia , perinatal mortality 5* higher than N
WtWt
 Congenital malformationCongenital malformation
 Multiple gestationMultiple gestation

14. ABNORMALABNORMAL
LABOUR/DYSTOCIA/FAILURE TOLABOUR/DYSTOCIA/FAILURE TO
PROGRESS IN LABOURPROGRESS IN LABOUR
3-Abnormalities in the powers3-Abnormalities in the powers
 Ineffective uterine activityIneffective uterine activity
 Lack of voluntary expulsive efforts in the 2Lack of voluntary expulsive efforts in the 2ndnd
stagestage
DYSTOCIA IS THE MOST COMMON INDICATIONDYSTOCIA IS THE MOST COMMON INDICATION
FOR CSFOR CS