caesarean section by um

CAESAREAN SECTION

Definition delivery of a fetus by incision

through the abdominal wall and uterus

Types of Caesarean Section

LSCS (Lower segment Caesarean section)

Upper segment / Classical Caesarean section

Transverse incision over the lower segment of the uterusRelatively avascularDoes not take an active part in contraction and retraction during labourAccess to the presenting part of the fetusEncourages good healing

Vertical incision over the fundus and body of the uterusMore vascularTakes an active part in contraction and retraction during laborDoes not give access to the presenting partPoor healing

Emergency Lower Segment Caesarean Section

Indications : Fetal distress CPD Umbilical cord prolapse Placenta abruptio Placenta praevia Failed instrumental delivery Failed IOL

Elective Lower Segment Caesarean Section

Indications : 2 / > previous Caesarean sections A previous classical Caesarean section CPD Placenta praevia Breech presentation Multiple pregnancy IUGR Tumours

Upper Segment Caesarean Section

1. avoided unless.. 2. Indications :

Inaccessible lower segment(fibroids) Impacted transverse lie Major placenta praevia Ca of cervix (prior to performing radical

hysterectomy) Post-mortem Caesarean section

Procedure

1. Anesthesia2. Abdominal incision3. Uterine incision4. Amniotic sac incision5. Delivery of baby6. Umbilical cord clamped7. Delivery of placenta8. Stiching of uterus

Anesthesia1. Elective

-regional anesthetics (spinal/epidural)-numbs only the lower portion of the body

2. Emergency - Spinal/GA -effect faster

1. Anaesthesia

2. Abdominal Incision

1. Elective Horizontal/transverse/

Pfannenstiel incision across the abdomen, just above the pubic area.

2. Emergency prefer a vertical cut,

from below the navel to just above the pubic area.

Transverse (Pfannenstiel)

Vertical

More popularLimited exposure

Hernia less common

Less popularRapid entry and good exposureHernia more common

3. Uterine incision The sheath, then

muscles of the uterus are separated, producing a hole for the delivery of the baby.

The incision can be either vertical incision or horizontal incision.

4. Amniotic sac incision

Cutting through the amniotic sac

The amniotic fluid is allowed to escape

5. Delivery of baby

Delivery of baby With one hand, the

surgeon reaches into the uterus and lifts the baby's head.

An assistant pushes down on the mother's upper uterus to help guide the baby out

6. Umbilical cord clamped and cut

7. Delivery of placenta

Delivery of placenta controlled cord traction

8. Stitching uterus is stitched closed (with

dissolvable stitches), inspect the ovaries and tubes, then close the different tissue layers

and put staples or stitches into the skin.

Stitch 3 layers for upper segment (thicker) and 2 layers for lower segment.

ComplicationsMATERNAL1. Infection. (genital tract, UTI, wound)2. Bleeding.3. Injury to bladder and bowel. 4. Anesthesia complication. 5. Thromboembolism.Next delivery 1. Uterine rupture 2. Placenta previa 3. Placenta accreta

Complications

BABY1. Premature birth. 2. Breathing problems. 3. Low Apgar scores. 4. Fetal injury.

Advantages

MATERNAL-Reduced uterovaginal prolapse-Reduced urinary incontinence

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