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SECOND STAGE CESAREAN
SECTION
Dr Ahmed Abdelmotaleb Kamal
Mbbch/g,o Diploma/Dirmas ART/Mrcpi
Introduction
• Incidence of second stage cesarean section is increasing in both
high/mid income countries and low income countries. Its technically
difficult to deliver a head which is deeply impacted inside the pelvis.
Its associated with maternal trauma and sometimes even fetal
trauma.
• Reasons are multifactorial, as a general increased failed operative
deliveries and reduced trials of operative delivery.
Risks ..compared with operative delivery
• Maternal ,,, increase of trauma(bladder-bowel-extened uterine
incision-cervix-vagina-broad ligament)-increased hemorrhage than
operative delivery-further c.s -more difficulty to conceive than
operative delivery-lesser urinary incontinence and constipation than
operative delivery at one year postpartum-endometritis and ssi.
• Neonatal ,,,trauma lesser than operative delivery – intracranial
hemorrhage lesser than operative delivery-more SCBU admission
than operative delivery-more perinatal asphyxia than first stage c.s –
neurodevelopmental delay at 5 y not defer between methods of
delivery.
management
• Vaginal examination prior to surgery.
• Whitmore position.
• Antibiotics prophylaxis.
• Joel-cohen incision.
• Higher incision of uterus.
• Methods of delivery ( head disimpaction) : use of tocolytics are questioned
1-push method from vagina by assistant while operator traction 2-
pull(reverse breach extraction)by grasping one or both feet of baby and
downward traction. 3-Patwardhan’s method (less common)delivery of both
fetal shoulders through the incision followed by the trunk, breech, and
then finally lifting the head out of the pelvis
Comparison between push and pull methods
• Push method associated with trauma to fetal head and increased
infection.
• Pull method associated with extension of cesarean incision and
neonatal trauma.
Devices
• The Foetal Disimpacting System:silicone balloon that can be inserted
through the vagina to rest under the fetal head, inflated with saline ,
to elevate the head.
• C-snorkel:anatomically curved
• tube with multiple
• ventilation ports.
postoperative
• Care with VTE risk assessment.
• Neonatology care.
• Bladder care and fluid output.
• Psychological issues as PTSD and postnatal depression.
• Care with breastfeeding assist.
• Incident reporting.

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second stage c.s-Dr Ahmed Abdelmotaleb .pptx

  • 1. SECOND STAGE CESAREAN SECTION Dr Ahmed Abdelmotaleb Kamal Mbbch/g,o Diploma/Dirmas ART/Mrcpi
  • 2. Introduction • Incidence of second stage cesarean section is increasing in both high/mid income countries and low income countries. Its technically difficult to deliver a head which is deeply impacted inside the pelvis. Its associated with maternal trauma and sometimes even fetal trauma. • Reasons are multifactorial, as a general increased failed operative deliveries and reduced trials of operative delivery.
  • 3. Risks ..compared with operative delivery • Maternal ,,, increase of trauma(bladder-bowel-extened uterine incision-cervix-vagina-broad ligament)-increased hemorrhage than operative delivery-further c.s -more difficulty to conceive than operative delivery-lesser urinary incontinence and constipation than operative delivery at one year postpartum-endometritis and ssi. • Neonatal ,,,trauma lesser than operative delivery – intracranial hemorrhage lesser than operative delivery-more SCBU admission than operative delivery-more perinatal asphyxia than first stage c.s – neurodevelopmental delay at 5 y not defer between methods of delivery.
  • 4. management • Vaginal examination prior to surgery. • Whitmore position. • Antibiotics prophylaxis. • Joel-cohen incision. • Higher incision of uterus. • Methods of delivery ( head disimpaction) : use of tocolytics are questioned 1-push method from vagina by assistant while operator traction 2- pull(reverse breach extraction)by grasping one or both feet of baby and downward traction. 3-Patwardhan’s method (less common)delivery of both fetal shoulders through the incision followed by the trunk, breech, and then finally lifting the head out of the pelvis
  • 5. Comparison between push and pull methods • Push method associated with trauma to fetal head and increased infection. • Pull method associated with extension of cesarean incision and neonatal trauma.
  • 6. Devices • The Foetal Disimpacting System:silicone balloon that can be inserted through the vagina to rest under the fetal head, inflated with saline , to elevate the head. • C-snorkel:anatomically curved • tube with multiple • ventilation ports.
  • 7. postoperative • Care with VTE risk assessment. • Neonatology care. • Bladder care and fluid output. • Psychological issues as PTSD and postnatal depression. • Care with breastfeeding assist. • Incident reporting.