CESAREAN SECTION

By
Zahraa majeed

DEFINITION

The delivery of a viable fetus through an

incision in the abdominal wall and uterus.
Definition does not include removal of fetus
from abdominal cavity in case of rupture
uterus.
WHO recommends an ideal caesarean rate
of 10- 25%..........

WHY RATES INCREASED?

Increase in repeat caesareans.

Difficult instrumental delivery and vaginal
breech deliveries
Increased diagnosis of intrapartum fetal
distress Caesarian on demand
Identification of risk of mothers and
fetuses
Increase in pregnancies by invitro
fertilization

TYPES OF CS

Lower uterine segment incision (LSCS) :

This is the commonest CS procedure. Involved
horizontal incision after reflecting visceral
peritoneum. the abdomen is opened by a low
midline ,paramedian and more commonly by a
pfannenstiel incision and peritoneal cavity
opened. the bladder is reflected from the lower
segment and transverse incision is made on the
lower uterine segment care being taken not to
injured the fetus.
The forceps can be used to assist delivery in a
cephalic presentation.
(LSCS) is commonest procedure because it
easier to incise the lower segement , deliver the
fetus from point of incision

and to approximate the layers because of thin

muscle layers compared with upper
segement .in addtion the peritoneal layer can
be closed and was thought to provid
advantage against infection .also blood loss
with LSCS is less.

Midline vertical incision

Commonly starts in the lower segment as a small
buttonhole incision till the uterine cavity is reached and
is extended upwards .because the difficulty the making
the incision , increased blood loss , inadequate
approximation at closure , increase post- operative
morbidity and inability to offer a trial of vaginal
delivery in the next pregnant due to possible higher
incidence of scar rupture .
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

INDICATIONS FOR ELECTIVE CS

Known CPD
Fetal macrosomia >
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

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

Urgent CS

There is maternal and fetal compromised but

not life threatening .here delivery should be
complteted within 60-75 min and cases with
FHR abnormalities are those of concern.

Sechualed CS
The mother need early delivery but not
maternal or fetal compromised there may
concern that continuation of pregnancy is
likely affect the mothe or fetus in hours or
days to come.

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

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

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

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

The end