You are on page 1of 6

1.

Classical Caesarean- Here the upper portion of the uterus is opened by an


incision and the baby is then extracted. This is not practiced anymore due to a
higher incidence of complications.

2. Lower Segment Caesarean Section- In this case, the uterus is opened in the lower
segment and the babys head or breech as the case may be is delivered.

3. Emergency C Section- When there is suspected danger to the mother's or babys


condition an emergency section is resorted to.

4. Elective Caesarean Section (Planned C-Section)- The caesarean is planned and


done on a specific date chosen by the patient and the doctor after assessing the
maturity of the baby.

Indications:

1. Emergency Caesarean section:


Fetal distress- During the course of labor or even before the onset of labour, if a
baby at or near full term, is found to have a slow or irregular heart rate, it signals
distress for the baby. The baby may also send SOS signals by passing meconium,
which becomes evident when the amniotic fluid leaks out. This could happen due to
separation of the placenta and bleeding, or many other problematic situations
affecting the mother. Likewise, if the umbilical cord slips out during labor the blood
supply to the baby could be hampered. If the baby is not delivered immediately at
this point of time, it could baby die even before being born. This is an emergency
situation and the baby has to be delivered immediately.
Maternal distress- If the mother is subjected to life-threatening eventuality during or
before labour, like excess bleeding or surge of blood pressure, an emergency
caesarean has to be done to save the mothers life.
Mechanical impedance to the progress of labor- The mother's birth passage being
too narrow, or the baby being oversized for the mothers birth canal or failure of the
contractions to progress as they should all lead to failure of the normal vaginal birth
and can endanger the baby's life necessitating Caesarean section.

2. Elective Caesarean section:


Previous Caesarean section quite often becomes an indication to deliver the next
child also by a caesarean section. Concerns about previous scar on the uterus giving
way during normal labor often leads to this decision.
Previous Classical Caesarean section also leads to a repeat Caesarean as these
scars tend to be rather weak and may tear open during a normal vaginal delivery.
Placenta praevia grade 4
Abnormal position of the baby such as breech or transverse lie where the baby lies
across the mothers womb.
Tumors within the mother's pelvic cavity, or large ovarian cysts
Genital herpes in the mother Here a Caesarean is resorted to so that the mothers
infection does not pass on to the baby during its journey in the mothers birth canal
Medical problems in the mother like high blood pressure, diabetes etc. are also dealt
with by Caesarean in centres
Triplets or more number of babies
HIV infection in the mother is another instance when Cesarean section is done to
prevent transmission of the infection to the baby in the course of a normal delivery.

Spinal Anesthesia is the commonest type of anesthesia used the world over
because of its ease of administration, safety for the mother and the baby, and early
return to normal activities including feeding the baby by the mother.

Epidural anesthesia is used in situations when it is already in place for a painless


labor, or in certain heart conditions wherein an epidural is safer than even a spinal
anesthetic.

General Anesthesia is administered when there are bleeding or clotting problems


in the woman which prevent a spinal or epidural or in cases of fetal distress, when
there isn't sufficient time to administer spinal anesthesia.fection in the mother is
another instance when Cesarean section is done to prevent transmission of the
infection to the baby in the course of a normal delivery.

1. Once the abdomen has been disinfected by means of an antiseptic solution, it is


opened via a curvilinear incision in the lower part of the abdomen, (laparotomy) a
few centimeters above the pubic
hairline. (Bikini incision)

2. The muscles over this region are incised and then the uterus is opened at its
lower portion. (Hysterotomy). Before the uterus is opened, care in taken not to
injure the urinary bladder, which lies very close to the uterus at this point. The
bladder is pushed downward and away from the area to be operated.

3. Once the uterus has been opened, the waters surrounding the baby is sucked out
and then the surgeon passes his hand into the uterus and grasps the presenting
part of the baby. This is the lowermost part of the baby present within the uterus-it
could be the babys head or breech, or occasionally its back.

Once the presenting part is within the doctors grasp, he gently pulls the baby out.
The babys mouth is immediately sucked to remove any water it may have
swallowed.

4. The umbilical cord is then clamped and cut to free the baby from the mother. The
baby is wrapped and taken under the pediatrician's care. The delivery of the baby in
a Cesarean section is accomplished in about 5 minutes or less to minimize the
effect of anesthesia and surgery on the baby.

5. Meanwhile, the placenta or after-birth is then removed from the mother's uterus.
The inside of the uterus is wiped clean to remove any bits of placental membrane
sticking to it. The opening in the uterus is then stitched up.

6. At this point the obstetrician may request the anesthetist to administer medicines
it shrink the expanded uterus quickly in size, almost to the pre-pregnancy level. This
will ensure that there is less bleeding from the uterus.

7. The abdomen is then closed and a sterile dressing is applied over the incision.

8. The mother is recovered from anesthesia and moved out of the operating theatre.
She is allowed to commence breast-feeding as early as possible.

Even though Caesarean as a surgical procedure has become a safe procedure in the
right hands, complications can arise during or after the operation.

Complications that could occur during the operation are:

1. Hemorrhage or Excess bleeding

2. Injury to the nearby structures like- ureters, urinary bladder, intestines.

3. Perforation or hole in the uterus.

4. Aspiration or inhalation of the contents of the stomach into the lungs during
anesthesia is the most dreaded complication of general anesthesia during a
caesarean section. This can be avoided to some extent by ensuring a minimum
starvation period of six hours for solid food and milk. This precaution may have to
be bypassed during an emergency

5. Amniotic fluid embolism is entry of amniotic fluid from the mother's womb into
the blood stream and then into the lungs. This complication carries a very high
mortality but fortunately it is also very rare. It cannot be prevented.

6. Shock due to excess bleeding

Post-operative late complications include:

1. Bleeding

2. Infection of the wound site

3. Thrombosis or clot formation in the large veins of the leg or hips can occur. If
these clots get dislodged from the leg and move into the lung, they can cause a
fatal complication called pulmonary embolus

4. Ileus or paralysis of the bowels for a couple of days which then recovers.

5. Atelectasis is collapse of a portion of the lungs, which is quite common after an


abdominal surgery under anesthesia.

6. Urinary tract infection is also a possible complication in the post-operative period

7. Fever can also annoy the mother occasionally

8. Headache due to the spinal anesthesia

9. Depression can also happen in the post-op period.

Recovery and recuperation

The patient is given antibiotics to prevent infection, painkillers to combat the pain,
medicines to counter the vomiting tendency, as well as medicines to shrink the
uterus to normal size.

After 24 hours she can start moving around and can even commence on a soft
diet.

The sutures are removed on the 4th day and if all is well, the mother is allowed to
go home.

Each individual requires 3-4 weeks to get back to normal. The mother can resume
normal activities after about a month.

You might also like