cesarean section tayebeh gharibi faculty of nursing&midwifery
TRANSCRIPT
CESAREAN SECTIONCESAREAN SECTIONTayebeh gharibi Tayebeh gharibi
Faculty of nursing&midwiferyFaculty of nursing&midwifery
TYPES OF CSTYPES OF CS
Lower segment CSLower segment CS Classical CSClassical CS
Indications for classical incision:Indications for classical incision: Transverse lie with SROMTransverse lie with SROM Structural abnormality that makes lower Structural abnormality that makes lower
segment approach difficultsegment approach difficult Constriction ring with neglected labourConstriction ring with neglected labour Fibroids in the lower segmentFibroids in the lower segment Ant PP & abnormally vascular lower segmentAnt PP & abnormally vascular lower segment Mother dead & rapid delivery is requiredMother dead & rapid delivery is required Very preterm fetus in breech presVery preterm fetus in breech pres
INDICATIONS FOR ELECTIVE CSINDICATIONS FOR ELECTIVE CS
Known CPDKnown CPD Fetal macrosomia Fetal macrosomia > >
4500 gm4500 gm Placenta previaPlacenta previa VV fistula repairVV fistula repair HIVHIV Active herpesActive herpes Repeat CSRepeat CS
Uterine surgery eg. Uterine surgery eg. Hystrotomy, Hystrotomy, myomectomymyomectomy
Severe IUGRSevere IUGR Breech Breech Multiple pregnancyMultiple pregnancy Transverse lieTransverse lie Ca of the Cx/ TR Ca of the Cx/ TR
obstructing the birth obstructing the birth canalcanal
INDICATIONS FOR EMERGRENCY CSINDICATIONS FOR EMERGRENCY CS
Abruptio placntaeAbruptio placntae Fetal distressFetal distress Failure to progress in the first stage of labourFailure to progress in the first stage of labour Cord prolapseCord prolapse Obstructed labourObstructed labour Failed inductionFailed induction Malpresentation Malpresentation brow, face, shoulder & brow, face, shoulder &
compound presentations, breechcompound presentations, breech Compromised fetus 2ry to DM, HPT, Compromised fetus 2ry to DM, HPT,
isoimmunization isoimmunization
مادری مادری اندیکاسیونهای اندیکاسیونهای
دائمی دائمی سرکالژ سرکالژ لگن لگن دفرمیته دفرمیته رحمی انسزیون رحمی گسیختگی انسزیون گسیختگی میومکتومی میومکتومی سابقه سابقه ژنیتال انسدادی های ژنیتال توده انسدادی های توده سرویکس مهاجم سرویکس سرطان مهاجم سرطان ریوی یا قلبی ریوی بیماری یا قلبی بیماری مغزی مغزی انوریسم انوریسم مرگ هنگام سزارین مرگ زایمان هنگام سزارین زایمان همزمان شکمی داخل جراحی مستلزم که همزمان ضایعاتی شکمی داخل جراحی مستلزم که ضایعاتی
هستندهستند
جنینی مادری جنینی اندیکاسیونهای مادری اندیکاسیونهای
لگنی سری تناسب لگنی عدم سری تناسب عدم ابزاری واژینال زایمان خوردن ابزاری شکست واژینال زایمان خوردن شکست ودکولمان پرویا ودکولمان پالسنتا پرویا پالسنتا
جنینی جنینی اندیکاسیونهای اندیکاسیونهای
بخش غیراطمینان بخش وضعیت غیراطمینان وضعیت غیرطبیعی غیرطبیعی نمایش نمایشماکروزومیماکروزومی مادرزادی مادرزادی ناهنجاری ناهنجاری بندناف عروق داپلر غیرطبیعی بندناف نتیجه عروق داپلر غیرطبیعی نتیجهترومبوسیتوپنیترومبوسیتوپنی قبلی نوزادان زایمانی ترومای قبلی سابقه نوزادان زایمانی ترومای سابقه
نوزادان نوزادان موربیدیتی موربیدیتی
شایعترین پوست شایعترین پارگی پوست پارگی
سفالوهماتومسفالوهماتوم
جمجمه جمجمه شکستگی شکستگی
فاسیال عصب فاسیال فلج عصب فلج
بیشترین . ابزاری واژینال زایمان شکست از پس بیشترین . سزارین ابزاری واژینال زایمان شکست از پس سزاریناسیب اسیب میزان میزان
الکتیو سزارین در آسیب میزان الکتیو کمترین سزارین در آسیب میزان کمترین
TIMING OF ELECTIVE CSTIMING OF ELECTIVE CS
For maternal interest For maternal interest no choice no choice For fetal interest For fetal interest consider maturity & fetal consider maturity & fetal
conditioncondition Usually at 38 wks Usually at 38 wks
Before Emergency CSBefore Emergency CS
Explain to the Pt & husband & obtain consent Explain to the Pt & husband & obtain consent
Inform anesthetist, OR staff, pedInform anesthetist, OR staff, ped
100% oxygen mask in case of fetal distress100% oxygen mask in case of fetal distress
Sodium citrate Sodium citrate 330 ml , metoclopramide 10 mg 0 ml , metoclopramide 10 mg IVIV
Transfer to the theatre, IV , take blood for Hb, Transfer to the theatre, IV , take blood for Hb, x-match 2 U of bloodx-match 2 U of blood
Preferable to use spinal or epidural anaethesiaPreferable to use spinal or epidural anaethesia
Catheterize the bladder Catheterize the bladder Tilt the mother 15 Tilt the mother 15 º by using wedgeº by using wedge Prophylactic Ab Prophylactic Ab ↓↓ incidence of infection↓↓ incidence of infection Inform ped if the mother had opiates in the last 4 Inform ped if the mother had opiates in the last 4
hrshrs Halothane should not be used Halothane should not be used uterine relaxation uterine relaxation
& bleeding& bleeding
COMPLICATIONSCOMPLICATIONS
INTRAOPERATIVEINTRAOPERATIVE Bleeding & the need for bl transfusionBleeding & the need for bl transfusion HysterectomyHysterectomy Complications of anaesthesiaComplications of anaesthesia Damage to the bladder, ureter, colon , retained Damage to the bladder, ureter, colon , retained
placental tissueplacental tissue Fetal injuryFetal injuryPOSTOPERATIVE POSTOPERATIVE Gaseous distensionGaseous distension Paralytic ileusParalytic ileus Wound dehiscence & infectionWound dehiscence & infection Infectins Infectins UTI, pulmonary UTI, pulmonary DVT & pulmonary embolismDVT & pulmonary embolism DeathDeath Vesico uterine fistulaVesico uterine fistula
POSTNATAL CAREPOSTNATAL CARE
V/S & blood loss must be moniteredV/S & blood loss must be monitered Uterine fundus palpated Uterine fundus palpated Effective parentral analgesicsEffective parentral analgesics Deep breathing & coughing encouragedDeep breathing & coughing encouraged Early mobilizationEarly mobilization Fluid therapy &dietFluid therapy &diet Bladder & bowel functionBladder & bowel function Wound careWound care LabLab Breast careBreast care Prophylaxis for thrombembolismProphylaxis for thrombembolism
MODE OF DELIVERY IN NEXT MODE OF DELIVERY IN NEXT PREGNANCYPREGNANCY
CRITERIA FOR VBACCRITERIA FOR VBAC Pt must agree to the procedurePt must agree to the procedure A low transverse uterine incisionA low transverse uterine incision Non recurrent cause of the previous CSNon recurrent cause of the previous CS No macrosomia, malposition, multiple No macrosomia, malposition, multiple
gestation, breechgestation, breechContraindicationContraindication Previous classical CSPrevious classical CS 2 or more previous CS2 or more previous CS Previous other uterine surgeryPrevious other uterine surgery Hx of scar ruptureHx of scar rupture Placentaprevia or transverse liePlacentaprevia or transverse lie
CONDUCT OF LABOURCONDUCT OF LABOUR
Similar to the conduct of normal labourSimilar to the conduct of normal labour
Observe forObserve for ProgressProgress Fetal wellbeingFetal wellbeing Maternal well beingMaternal well being Cx may be ripenedCx may be ripened Labour may be agumented Labour may be agumented Epidural & other analgesics may be usedEpidural & other analgesics may be used HOSPITAL SHOULD PROVIDE BLOOD , HOSPITAL SHOULD PROVIDE BLOOD ,
OPERATING ROOM 24 HRS, NEONATAL OPERATING ROOM 24 HRS, NEONATAL RESUSCITATION, NURSING ANAESTHESIA RESUSCITATION, NURSING ANAESTHESIA &SURGICAL PERSONNEL CAN START CS &SURGICAL PERSONNEL CAN START CS WITHIN 30 MIN WITHIN 30 MIN
SCAR RUPTURESCAR RUPTURE
O.2-1.5% for LSCSO.2-1.5% for LSCS 4-9% for classical4-9% for classical
INDICATIONS OF SCAR RUPTUREINDICATIONS OF SCAR RUPTURE Fetal distressFetal distress Ease of fetal palpationEase of fetal palpation Cessation of contractionsCessation of contractions Elevation of presenting partElevation of presenting part Scar painScar pain Bleeding / shockBleeding / shock
ABNORMAL ABNORMAL LABOUR/DYSTOCIA/FAILURE TO LABOUR/DYSTOCIA/FAILURE TO
PROGRESS IN LABOURPROGRESS IN LABOUR
CAUSESCAUSES
1-Abnormalities of the pasage 1-Abnormalities of the pasage
Alteration in the shape of the pelvisAlteration in the shape of the pelvis Mass occupying the birth canalMass occupying the birth canal
ABNORMAL ABNORMAL LABOUR/DYSTOCIA/FAILURE TO LABOUR/DYSTOCIA/FAILURE TO
PROGRESS IN LABOURPROGRESS IN LABOUR2-Abnormalities in the passenger2-Abnormalities in the passenger Abnormal lie Abnormal lie Abnormal presentationAbnormal presentation
occiput-postrior, occiput-transverseocciput-postrior, occiput-transverse
browbrow
faceface
breechbreech Macrosomia , perinatal mortality 5* higher Macrosomia , perinatal mortality 5* higher
than N Wtthan N Wt Congenital malformationCongenital malformation Multiple gestationMultiple gestation
ABNORMAL ABNORMAL LABOUR/DYSTOCIA/FAILURE TO LABOUR/DYSTOCIA/FAILURE TO
PROGRESS IN LABOURPROGRESS IN LABOUR3-Abnormalities in the powers3-Abnormalities in the powers Ineffective uterine activityIneffective uterine activity Lack of voluntary expulsive efforts in the 2Lack of voluntary expulsive efforts in the 2ndnd
stagestage
DYSTOCIA IS THE MOST COMMON INDICATION DYSTOCIA IS THE MOST COMMON INDICATION FOR CSFOR CS