C - section

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C - section

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Objectives

• Define the condition. -
• - List the indications .
• - List the types incidence of each.
• - State the preop preparation.
• - Describe the procedure.
• - List the complications .

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C-section

• surgical procedure to deliver one or more babies
• usually performed when a vaginal delivery is a
  risk for mother or baby

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INDICATIONS

• Major indication
• 1-previous caesarean section
• 2-prolonged labour or a failure to progress
  (dystocia)
• 3-malpresentation
• 4-Suspected acute fetal compromise
• ,

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INDICATIONS

• multifetal pregnancy,
• Abruption placenta ,placenta praevia ,
• fetal disease,
• maternal disease. increased heart rate
  (tachycardia) in the mother or baby after
  amniotic rupture,
• increased blood pressure (hypertension) disease,
• large baby weighing gt4000g (macrosomia)

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TYPES of C-section

• according to the type of incision (longitudinal
  or transversal) made on the uterus, apart from
  the incision on the skin
• - classical Cesarean section involves a
  midline longitudinal incison
• - lower uterine segment section is the procedure
  most commonly used today

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TYPES of C-section

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• Caesarean hysterectomy -consists of a Cesarean
  section followed by the removal of the uterus
• repeat Caesarean section - done when the patient
  had a previous Cesarean section

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Preoperative preparation for caesarean section

• - The patient should be aware of the indications
  for the Caesarean section, the alternatives, the
  potential risks, benefits, and complications.
• Then she signs a form indicating that she has
  received the appropriate information and consents
  to the procedure.

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Preoperative preparation for caesarean section

• An intravenous 18-gauge needle should be in
  place with an appropriate intravenous solution
  running before the operation begins.
• Antacid should be giving to her to minimize the
  likelihood of aspiration during anesthesia.
• Foley catheter.
• Anesthesia is administrated and the abdomen is
  prepped.
• She is covered with sterile drapes.
• Tilt the patient slightly to the left to minimize
  the pressure on the IVC.

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Operative procedure

• Abdominal incision
• Most obstetricians use the transverse
  (pfannenstial) incision, because wound dehiscence
  is rare and the cosmetic result is usually
  better.
• In urgent situations they usually use the midline
  vertical suprapubic incision because it's much
  quicker and the exposure for expeditious delivery
  and resolving uterine bleeding usually better.
• In the presence of a prior abdominal scar it's
  important to enter the peritoneal cavity at the
  upper end of the incision to avoid entering the
  bladder, which may have pulled up in the closure
  of the previous incision.

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Operative procedure

• Uterine incision
• Before uterine incision is made, laparotomy pads
  can be placed on either side of the uterus to
  catch the spill of the amniotic fluid.
• The degree of dextrorotation should also be
  determined by notting the position of the round
  ligament so that the uterine incision will be
  centered.
• Most often uterine incisions are classical
  uterine incision and low transverse uterine
  incision.

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Operative procedure

• Encountering the placenta
• If the placenta is encountered beneath the
  uterine incision the operator should avoid
  cutting through it to avoid serious fetal
  bleeding, if it cannot be avoided the baby should
  be delivered as quick as possible and the cord
  should clamped to avoid the bleeding.

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Operative procedure

• Delivery
• The operator delivers the baby then delivers the
  placenta, uterine massage should take place to
  minimize the amount of bleeding.
• Oxytocin administrated to maintain firm
  contraction.
• The uterine cavity is wiped clean with a sponge
  to remove any retained membranes.
• The uterus is exteriorized, and active bleeding
  sinuses are clamped.

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Operative procedure

• Closure of the uterine incision
• It depend on the type of the incision but in
  general, the entire thickness of the myometrium
  should be closed
• In order to potentially decrease the likelihood
  of the uterine rupture during the subsequent
  pregnancy, the uterine incision should be closed
  in 2 layers.

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complication

• intraoperative complication
• 1-Bowel damage
• 2- caesarean hysterectomy
• 3- haemorrhage
• 4- placenta praevia placenta increase linearly
  after caesarean section
• 5- urinary tract damage

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• Post operative complication
• 1-infection and endometritis
• 2- pulmonary embolism and deep vein thrombosis
• 3- hernia
• 4- psychological

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