CESAREAN SECTION once a cesarean, always a cesarean has been changed to Once a cesarean always a Hospitalization

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CESAREAN SECTION

is a surgical procedure in which one or more incisions are made through a mother's abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies, or, rarely, to remove a dead fetus.

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The five Most Common Causes of Cesarean Section CS on Request Routine repeat cesareans . Dystocia (non-progressive labor) . Abnormal fetal presentation eg breech , transeverse , cord presentation . Fetal distress .

TYPES OF CS

The classical Caesarean section involves a midline longitudinal incision which allows a larger space to deliver the baby. However, it is rarely performed today, as it is more prone to complications. The lower uterine segment section is the procedure most commonly used today; it involves a transverse cut just above the edge of the bladder and results in less blood loss and is easier to repair. An unplanned Caesarean section is performed once labour has commenced due to unexpected labor complications.
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TYPES OF CS

A crash/emergent/emergency Caesarean section is performed in an obstetric emergency, where complications of pregnancy onset suddenly during the process of labour, and swift action is required to prevent the deaths of mother, child(ren) or both. A planned caesarean (or elective/scheduled caesarean), arranged ahead of time, is most commonly arranged for medical reasons and ideally as close to the due date as possible.

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TYPES OF CS

A Caesarean hysterectomy consists of a Caesarean section followed by the removal of the uterus. This may be done in cases of intractable bleeding or when the placenta cannot be separated from the uterus. Traditionally, other forms of Caesarean section have been used, such as extraperitoneal Caesarean section or Porro Caesarean section. a repeat Caesarean section is done when a patient had a previous Caesarean section. Typically it is performed through the old scar.
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INDICATIONS FOR ELECTIVE CS

Uterine surgery eg. Hystrotomy, myomectomy Known CPD Severe IUGR Fetal macrosomia > 4500 gm Breech Placenta previa Multiple pregnancy VV fistula repair Transverse lie HIV Ca of the Cx/ Active herpes TR obstructing the birth canal Repeat CS
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INDICATIONS FOR EMERGRENCY CS

Severe PET Abruptio placentae 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

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Consent for CS Consent for CS should be requested after providing pregnant women with evidence based information and in a manner that respects the womans dignity, privacy, views and culture whilst taking into consideration the clinical situation.

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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

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Transfer to the theatre, IV , take blood for Hb, x-

Before Emergency CS

Catheterize the bladder Tilt the mother 15 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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Maternal Position During CS

All obstetric patients undergoing CS should be positioned with left lateral tilt to avoid aorto-caval compression By tilting the operating table to the left

or place a pillow or folded linen under her right lower back

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Anaesthesia

1 General anaesthetic. 2 Regional anaesthesia ( Epidural block. Spinal block ). 3 Infiltration of local anaesthetic agents.

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Abdominal entry

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Uterine Incision

Abdominal cesarean section

Extraperitoneal cesarean section Latzko operation intraperitoneal cesarean section

1-Cervical A-- a transverse or curved (horizontal) Kerr operation Low transverse if cx is dilated less than 5 cm High transverse if cx is dilated more than 5 cm B--vertical incision in the lower uterus Selheim operation

2 -Classical--a vertical incision in the main body of the uterus. Sanger operation 3-Inverted T-shaped incision Delee operation 4 -J shaped

Vaginal cesarean section

COMPLICATIONS INTRAOPERATIVE

Bleeding & the need for bl transfusion Hysterectomy Complications of anaesthesia

Damage to the bladder, ureter, colon , retained placenta tissue Fetal injury

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COMPLICATIONS 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
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Lab