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CAESARIAN SECTION

Dr.P.S.Hettipathirana
MBBS(COL),MD(Obs & Gyn),MRCOG(UK)
Senior lecturer/ Consultant Obstetrician &
Gynaecologist
Definition
• Surgical procedure used to deliver baby or babies
through an incision in mother’s abdomen and
uterus after the 28th week of gestation

• Hysterotomy – If done before the 28th week


Classification

Elective C. sections

Emergency C. Sections
• LOWER SEGMENT
1. Lower segment transverse incision
– 90% of C/S
2. Low vertical (De Lee) incision Made parallel to the
longitudinal axis of the uterus in the midline but keeping
mainly to the lower segment

• UPPER SEGMENT
Classical incision - Made by incising the uterus parallel to
the longitudinal axis of the uterus in the midline
Indication For Caesarean section
• Usually performed when a vaginal delivery would put the baby
‘s or mother’s life or health at risk
• Maternal indications
1. Severe pre- eclampsia with unfavourable cervix
2. Previous classical caesarean delivery
3. Previous extensive uterine surgery with entry into the
uterine cavity eg : myomectomy
4. Obstructive pelvic tumours : eg friboids, ovarian cysts
5. Previous 3rd degree perineal tears with residual symptoms
6. Uterine rupture
7. Previous successful vesico vaginal fistula repair
8. Maternal STD - Vulval herpes simplex (primary infection),
HIV infection,
9. Maternal health problems. Eg :heart disease or lung disease
• Foetal indications
1. Foetal distress
2. Abnormal presentations –
Breech, brow, face with mento – Posterior
3. Abnormal lies – Transverse, oblique
4. Multiple gestations –
Complicated twin pregnancy triplets and higher order gestations
5. Foetal macrosomia – Weight >4500g
6. Foetal abnormality –Hydrocephalus, conjoint twins,
spina bifida
7. Very low birth weight
• Feto maternal indications
1. Cephalo-pelvic disproportion
2. Failure to progress
3. Major degree placenta praevia
4. Placental abruption with a live fetus
5. Failed induction of labour
6. Failed instrumental delivery
Preoperative preparation
• Take full history
Past medical and surgical history, Current medications ,History of
drug allergies
Do physical examination BP, Pulse, heart auscultation
Abdominal examination – foetal lie ,foetal presentation and
engagement,etc..
• Take informed consent for the surgery
• Do necessary Laboratory investigations –Hb,Urinalysis, BT/CT
platelet count ( when necessary)
More extensive investigations in complicated cases like
hypertension,cardiac diseases etc..
Do grouping & saving of blood - usually 1 unit
placenta praevia,Abruption, plcenta accreta -need more blood
• Send theater list
• Inform paediatric team
• Inform theater and anaesthetist
• If patient has co-morbid factors - multidisciplinary approach by
relevant specialities
• Keep fasting – At least 6 hrs
• Pre – medication
Antacids - Ranitidine / Cimetidine
In routine LSCS - in the night and morning at least 1 hr before
surgery
Na citrate - ½ hr before surgery
Antiemetics –Metachlopramide/promethazine
• Catheterize the patient
• Check for foetal life by listening to the foetal heart rate just
before starting C/S
Anaesthesia for Caesarean section
• Regional anaesthesia
Spinal
epidural
combined spinal and epidural anaesthesia
Safer and results in less maternal and neonatal morbidity
than GA
It allows the mother to be awake and interact
immediately with her baby
Less chance of aspiration
• General anaesthesia
Better for Very urgent C/S
Placental abruption ,Severe fetal distres, Patients with
heavy uncontrolled bleeding
Post procedure care
• Women should be observed on a one-to-one basis until regained airway
control and cardio-respiratory stability
Check BP,PR,UOP,Fundus,vaginal bleeding
• Give appropriate analgesic drugs
• Antibiotics
• Thromboprophylaxis
Graduated stockings, hydration, early mobilisation, heparin
• Removal of the urinary catheter should be carried out once a woman is
mobile
• Management of other complications should be continued Eg :
Hypertension , GDM ,etc…
• Assessing the wound for signs of infection (increasing pain, redness or
discharge), separation or dehiscence
• Women should resume activities such as driving a vehicle, formal
exercise and sexual intercourse once they have fully recovered
• Take medical advice promptly
1. If there is Any signs of infection
Fever,Severe pain in abdomen
Redness,swelling and discharge at incision
Foul-smelling vaginal discharge
Burning sensation with urination
2.Heavy bleeding or passing large clots
3.Swollen, red or painful areas in legs
4.Consistently low mood
Advantages of Caesarean section
1. Predictability
2. Timing
3. Preservation of the pelvic floor
Disadvantages of Caesarean
section
• Complications to mother
1. Increase maternal mortality - 6 times over NVD
2. Anaesthetic complications
3. Haemorrhage
4. Injury to near by organs – bladder, blood
vessels,ureter, bowel
5. Wound infection
6. Endometritis
7. DVT( about 4 times greater after a C/S than NVD )
8. Pulmonary embolism
9. Post spinal headaches
10. Risks of post-operative adhesions
11. Incisional hernias
12. Long hospital stay
13. Reduced fertility
14. Anemia
15. Decreased bowel function
16. UTI
Complications to Baby

1. Breathing problems-
Transient tachypnia of new-born , RDS
2. Foetal injury due to the uterine incision and
extraction
3. Neonatal depression due to anaesthesia
4. Iatrogenic Prematurity

Complications in next pregnancy


Placenta previa,APH,Placenta accreta,Uterine rupture