project

1. CESAREANCESAREAN
SECTIONSECTION
DR. SALWA NEYAZI
CONSULTANT OBSTETRICIAN GYNECOLOGIST
PEDIATRIC & ADOLESCENT GYNECOLOGIST

2. Name:- Kirpal Kumar R.
Group no -27
Subject- Obstetrics
opic- Cesarean section operation

3. TYPES OF CSTYPES OF CS
 Lower segment CSLower segment CS
 Classical CSClassical CS
Indications for classical incision:Indications for classical incision:
 Transverse lie with SROMTransverse lie with SROM
 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
 Ant PP & abnormally vascular lower segmentAnt PP & abnormally 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

4. 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 Cx/ TRCa of the Cx/ TR
obstructing the birthobstructing the birth
canalcanal

5. 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 2ry to DM, HPT,Compromised fetus 2ry to DM, HPT,
isoimmunizationisoimmunization
 APHAPH

6. 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

7. Before Emergency CSBefore Emergency CS
 Explain to the Pt & husband & obtain consentExplain to the Pt & husband & obtain consent
 Inform anesthetist, OR staff, pedInform anesthetist, OR 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, IV , take blood for Hb, x-Transfer to the theatre, IV , take blood for Hb, x-
match 2 U of bloodmatch 2 U of blood
 Preferable to use spinal or epidural anaethesiaPreferable to use spinal or epidural anaethesia

8.  Catheterize the bladderCatheterize the bladder
 Tilt the mother 15Tilt the mother 15 º by using wedgeº by using wedge
 Pneumatic inflatable boots or Ted stockingsPneumatic inflatable boots or Ted stockings
 Prophylactic AbProphylactic Ab ↓↓ incidence of infection↓↓ incidence of infection
 Inform ped if the mother had opiates in the last 4Inform ped if the mother had opiates in the last 4
hrshrs
 Halothane should not be usedHalothane should not be used uterine relaxationuterine relaxation
& bleeding& bleeding

9. 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

10. 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

11. MODE OF DELIVERY IN NEXTMODE OF DELIVERY IN NEXT
PREGNANCYPREGNANCY
CRITERIA FOR VBACCRITERIA FOR VBAC
 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
 Hx of scar ruptureHx of scar rupture
 Placentaprevia or transverse liePlacentaprevia or transverse lie

12. 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 agumentedLabour may be agumented
 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

13. SCAR RUPTURESCAR RUPTURE
 O.2-1.5% for LSCSO.2-1.5% for LSCS
 4-9% for classical4-9% for classical
INDICATIONS OF SCAR RUPTUREINDICATIONS OF SCAR RUPTURE
 Fetal distressFetal distress
 Ease of fetal palpationEase of fetal palpation
 Cessation of contractionsCessation of contractions
 Elevation of presenting partElevation of presenting part
 Scar painScar pain
 Bleeding / shockBleeding / shock

14. ABNORMALABNORMAL
LABOUR/DYSTOCIA/FAILURE TOLABOUR/DYSTOCIA/FAILURE TO
PROGRESS IN LABOURPROGRESS IN LABOUR
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

15. 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

16. 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