OPERATIVE DELIVERY

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OPERATIVE DELIVERY

• Dr Jacqueline Woodman
• Consultant Obstetrician Gynaecologist

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Caesarean Section

• A Caesarean section is a surgical procedure in
  which an incisions is made in the uterus to
  deliver one or more babies
• The first modern Caesarean section was performed
  by German gynaecologist Ferdinand Adolf Kehrer in
  1881.

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Indications for Caesarean Section

• Placenta praevia
• Transverse lie
• Previous classical Caesarean section
• Obstructed labour
• e.g. cephalo-pelvic disproportion,
• failure to progress
• Breech presentation
• Abruptio placenta
• Previous repeated Caesarean section
• Fetal indications
• Congenital abnormality
• e.g. severe hydrocehalus
• Multiple pregnancy
• e.g. first twin breech, triplets
• Cord prolapse
• Severe preterm IUGR
• Maternal request e.g. tokophobia

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Planned Caesarean section will increase the
following risks

• Maternal
• Longer hospital stay
• Bleeding that requires a hysterectomy
• Heart attack
• Neonatal
• ICU admission

http//www.nice.org.uk/nicemedia/live/13620/57166/
57166.pdf
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Risks of Caesarean section

• Maternal
• Haemorrhage 5 per 1000
• Hysterectomy 8 per 1000
• Infection 6 per 100
• Thrombosis 4-16 per 10 000
• Visceral and / or vascular injury
• Bladder injury 1 per 1000
• Anaesthetic risks
• Death 1 per 12 000
• Future pregnancy
• antepartum stillbirth 1-4 per 1 000
• Uterine rupture 2-7 per 1000
• Placenta accreta 4-8 per 1000

• Neonatal
• Tansient tachypnoea of the newborn
• (TTN)
• Injury to baby 1-2 per 100

http//www.rcog.org.uk/guidelines
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Caesarean section the procedure

• Skin incision and entry?
• Joel Cohen vs Phannelstiel a 65 reduction in
  reported postoperative morbidity with the
  Joel-Cohen incision.
• Incision of uterus
• transverse lower segment vs Classical
• Closure of the uterus
• 1 vs 2 layer
• Closure of the abdomen
• peritoneum, sheath, subcutaneous, skin

http//apps.who.int/rhl/reviews/CD004453.pdf
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Classification of urgency of Caesarean section

• Maternal or fetal compromise
• 1. Immediate threat to life
• 2. No immediate threat to moterh or baby
• 3. Requires early delivery
• No maternal or fetal compromise
• 4. At a time convenient to all

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Operative Vaginal Delivery

• Ventouse
• Forceps

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Indications for ventouse / forceps

• Failure to progress in second stage
• Fetal distress in second stage
• Maternal exhaustion
• Maternal conditions e.g. Heart conditions

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Conditions for a ventouse / forceps

• Fully dilated
• Maternal consent
• Station and position of fetal head known
• Bladder empty
• Lithotomy
• Analgesia

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Thank you
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References

• NICE
• CEMACH
• RCOG