CESAREAN SECTION

DR. SALWA NEYAZI

CONSULTANT OBSTETRICIAN GYNECOLOGIST
PEDIATRIC & ADOLESCENT GYNECOLOGIST

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

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

TIMING OF ELECTIVE CS

For maternal interest no choice

For fetal interest consider maturity & fetal
condition
Usually at 38 wks

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

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

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

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

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

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

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

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