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Section
Dr Khaled Baiomy
.Prof. Ob/GynOb/Gyn
Cesarean Delivery
Cesarean Section
It is commonly believed to be
derived from the surgical birth of
Julius Caesar, however this seems
unlikely since his mother Aurelia
is reputed to have lived to hear of
.her son's invasion of Britain
Incidence
5% in 1970 & 25% in 1990
.increased 0.6% to 3%( Chicago),1910-1928
.In 1965,United States was 4.5%
In 1980,16.5%, and it peaked at 24.7% in
. 1988
In 1985, the cesarean delivery rate in
America was 22.7%; 19% in Canada, 13% in
.Denmark, 10% in England, and 7% in Japan
In KAASH, 16-18%
Indications of CS
Maternal indications
Cont. pelvis and CPD -Pelvic
tumors
APH - HDP - Abnormal uterine
action
Previous uterine scar.
Previous successful repair of
vesico-vaginal fistula.
Previous caesarean section if,
.etc
?Why CS
Malpresentations
and
Foetal indications
malpositions
Prolapsed pulsating cord or
foetal distress
Diabetes mellitus
Bad obstetric history as
recurrent IUFD
Post-mortem C.S. done within
10 minutes
of maternal death
Disadvantages of elective
C.S
Transperitoneal CS
Extraperitoneal CS
Preoperative details
NPO at least 8 hours prior to arriving.
IV line
CBC and type and screen (Blood).
Cross-match blood to be available
IV FluidLactated Ringer solution or saline with
5% dextrose.
The patient is placed on an external fetal
monitor.
Evaluation by the operating physician &
anesthesiologist.
Intra-operative details
Pfannenstiel
Longer to enter the
peritoneal cavity,
Less painful,
Smaller risk of
incisional hernia,
Cosmetically.
The emergent nature of the procedure: FHR, urinarycatheter, & scrub and shave abdomen
The fetus should be protected from lacerationsThe infant should be immediately handed to someonetrained in infant resuscitation
Closure should be undertaken based on maternalcircumstances
Avoiding needless blood lossThe rules of dirty surgery should apply, and any broad-spectrum
.antibiotics )cephalosporin( in a single dose should be adequate
Opening uterus
U.C Clamping
Skin
Indications
Procedure
. Abdominal incision: is vertical
Uterine incision : 10 cm vertical incision is made in the midline
of upper uterine segment without incising the peritoneal coat
.separately as it is adherent in the upper segment
. Extraction of the foetus: as a breech in cephalic presentation
The last layer of the uterine incision closure includes the
superficial part of the myometrium with the peritoneal
. covering
.The remainder of the procedure is as lower segment C.S
BTL
Caesarean
Hysterectomy
.Un-controllable postpartum hge-1
.Un-repairable rupture uterus-2
.Operable cancer cervix-3
.Couvelaires uterus-4
Placenta accreta cannot be-5
.separated
.Severe uterine infection Cl. Welchii-6
Multiple uterine myomas in a woman-7
.not desiring future pregnancy
Postoperative details
In the recovery room :
Vital signs / 15 minutes for the first 1-2 hours, urine output /
hourly basis.
D/C, IVF
intake,
Complications
I Operative
1- Primary maternal mortality
is 4 times that of vaginal
delivery
i- Shock .
ii- Anesthetic complications
particularlyMendelsonsynd.
iii- Haemorrhage usually
due to extension of the
uterine
incision to the uterine
vessels, atony of the uterus
or DIC.
2- Injuries to the bladder or
ureter.
3- Foetal injuries
II Post-operative:
(A) Early:
Thrombosis and pulmonary
embolism.
Acute dilatation of the
stomach and paralytic
ileus.
Wound infection, puerperal
sepsis and burst abdomen.
Chest infection.
(B) Late :
Rupture of the uterine scar.
An atonic uterus
Multiple gestation,
Polyhydramnios, or
Failed attempt at a vaginal delivery
(prolonged).
Massage and Intravenous oxytocin, Consider
Intramuscular injections of prostaglandin (15methyl-prostaglandin, Hemabate) or
methylergonovine and repeat as appropriate.