CESAREAN SECTION

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CESAREAN SECTION

• DR. SALWA NEYAZI
• CONSULTANT OBSTETRICIAN GYNECOLOGIST
• PEDIATRIC ADOLESCENT GYNECOLOGIST

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TYPES OF CS

• Lower segment CS
• Classical CS
• Indications for classical incision
• Transverse lie with SROM
• Structural abnormality that makes lower segment
  approach difficult
• Constriction ring with neglected labour
• Fibroids in the lower segment
• Ant PP abnormally vascular lower segment
• Mother dead rapid delivery is required
• Very preterm fetus in breech pres

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INDICATIONS FOR ELECTIVE CS

• Known CPD
• Fetal macrosomia gt 4500 gm
• Placenta previa
• VV fistula repair
• HIV
• Active herpes
• Repeat CS

• Uterine surgery eg. Hystrotomy, myomectomy
• Severe IUGR
• Breech
• Multiple pregnancy
• Transverse lie
• Ca of the Cx/ TR obstructing the birth canal

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INDICATIONS FOR EMERGRENCY CS

• Severe PET
• Abruptio placntae
• Fetal distress
• Failure to progress in the first stage of labour
• Cord prolapse
• Obstructed labour
• Failed induction
• Malpresentation ? brow, chin post, shoulder
  compound presentations, breech
• Compromised fetus 2ry to DM, HPT, isoimmunization
  
• APH

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TIMING OF ELECTIVE CS

• For maternal interest ? no choice
• For fetal interest ?consider maturity fetal
  condition
• Usually at 38 wks

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Before Emergency CS

• Explain to the Pt husband obtain consent
• Inform anesthetist, OR staff, ped
• 100 oxygen mask in case of fetal distress
• Sodium citrate 20 ml , metoclopramide 10 mg IV
• Transfer to the theatre, IV , take blood for Hb,
  x-match 2 U of blood
• Preferable to use spinal or epidural anaethesia

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• Catheterize the bladder
• Tilt the mother 15 º by using wedge
• Pneumatic inflatable boots or Ted stockings
• Prophylactic Ab ?? incidence of infection
• Inform ped if the mother had opiates in the last
  4 hrs
• Halothane should not be used ?uterine relaxation
  bleeding

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COMPLICATIONS

• INTRAOPERATIVE
• Bleeding the need for bl transfusion
• Hysterectomy
• Complications of anaesthesia
• Damage to the bladder, ureter, colon , retained
  placental tissue
• Fetal injury
• POSTOPERATIVE
• Gaseous distension
• Paralytic ileus
• Wound dehiscence infection
• Infectins ? UTI, pulmonary
• DVT pulmonary embolism
• Death
• Vesico uterine fistula

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POSTNATAL CARE

• V/S blood loss must be monitered
• Uterine fundus palpated
• Effective parentral analgesics
• Deep breathing coughing encouraged
• Early mobilization
• Fluid therapy diet
• Bladder bowel function
• Wound care
• Lab
• Breast care
• Prophylaxis for thrombembolism

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MODE OF DELIVERY IN NEXT PREGNANCY

• CRITERIA FOR VBAC
• Pt must agree to the procedure
• A low transverse uterine incision
• Non recurrent cause of the previous CS
• No macrosomia, malposition, multiple gestation,
  breech
• Contraindication
• Previous classical CS
• 2 or more previous CS
• Previous other uterine surgery
• Hx of scar rupture
• Placentaprevia or transverse lie

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CONDUCT OF LABOUR

• Similar to the conduct of normal labour
• Observe for
• Progress
• Fetal wellbeing
• Maternal well being
• Cx may be ripened
• Labour may be agumented
• Epidural other analgesics may be used
• HOSPITAL SHOULD PROVIDE BLOOD , OPERATING ROOM 24
  HRS, NEONATAL RESUSCITATION, NURSING ANAESTHESIA
  SURGICAL PERSONNEL CAN START CS WITHIN 30 MIN

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SCAR RUPTURE

• O.2-1.5 for LSCS
• 4-9 for classical
• INDICATIONS OF SCAR RUPTURE
• Fetal distress
• Ease of fetal palpation
• Cessation of contractions
• Elevation of presenting part
• Scar pain
• Bleeding / shock

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ABNORMAL LABOUR/DYSTOCIA/FAILURE TO PROGRESS IN
LABOUR

• CAUSES
• 1-Abnormalities of the pasage
• Alteration in the shape of the pelvis
• Mass occupying the birth canal

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ABNORMAL LABOUR/DYSTOCIA/FAILURE TO PROGRESS IN
LABOUR

• 2-Abnormalities in the passenger
• Abnormal lie
• Abnormal presentation
• ? occiput-postrior, occiput-transverse
• ?brow
• ?face
• ?breech
• Macrosomia , perinatal mortality 5 higher than N
  Wt
• Congenital malformation
• Multiple gestation

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ABNORMAL LABOUR/DYSTOCIA/FAILURE TO PROGRESS IN
LABOUR

• 3-Abnormalities in the powers
• Ineffective uterine activity
• Lack of voluntary expulsive efforts in the 2nd
  stage
• DYSTOCIA IS THE MOST COMMON INDICATION FOR CS