tion

.
The
town
!
Cesarean Section on buah Definition It is an
operative procedure where by the fetus after the end of
28th weeks are delivered through lan incision on the
abdominal a uterine walls.
Primary cs - first operation performed on a patient
Repeat cs - When the operation is performed in
O subsequent pregnancies. Incidence Steadily rising
- abt 2-3 fold rise from initial rate of 10% Indications.
Absolute Indication de
Relative Indication:
CCCPAVA
CCPD-MAN-FB-MOH) vaginal
delivery is not possibly = vaginal delivery may be possible
Testo needed arne dead fetic. but risk to the mother baby
are high.
DCPD . Dl Central placenta previa h Previous Cesarean
delivery indian
3 bustocia 23 Langues la
materning 2 Contracted pelvis / CPD. O malpuesentation
Codech she dicta smo
APH (placenta previa)
Abeuptio placent) 3 Pelvic mass (cervical benytte din Non
seassurine che :
Advanced carcinoma CervikaFailed swegical induction
failuge, they 3 vaginal obstruction (3) Bad obskthic history
3 Catresia, stenosis)o Medical gynecological
disorde's.
TDM, Heast disease, pelvic tumon,
CAL 2 On Maternal request 16)
Hypertensive disorders.
(Preeclampsia,
eclampsia)

Scanned with
CamScanner
Types of operation. Han * Lower segment
Cesarean section (Lsco)
In this operations, the extraction of the baby is done the ough
an incision made in the lower Segment
theorth a transperitoneal approach. * It is the only me thered
practiced, in passent day obstenlaics. * classical / upper
segment cesarean section.
In this opecation, the baby is extracted through an incision
made in the upper segment of the culteus. - Its indications
 are
approach
Lower segment
dense adhesion /
Severe
is difficult howe segment appeach is risky - CA cx / Complete
pendulous abdos
and placenta puvian
Limostem os e in 10 min of maternal death to save the
live baby.
incisioni

Contracted Pelvis e

LSCS
nich
Preoperative preparation *Infomed written permission to
the procedure , anesthesia
BT.
Cconsent toy er en *Npo for min of he before Surgery *
Abdomen is scrubbed ê Soap & nonorganic iodide lotion * Past
peeparation Ċ Hais may be clipped). * Premadicative
Sedatives must not be given. * Ranitidine ( H2 blocked) 150
mg orally night before a repeated
song IM/Iv he before surgery o raise gastric pti. * Soap
water enema to empty the stomach. + Bladder should be
emptied by a foley cather before shifting
Scanned with
CamScanner
:

TOOT.
* FHS should be checked
so t hat Neonatologist
should be made available * cross match blood should kept
ready Cin Suspected cases) + IV. canula - to 'administer
fluids (RL, 570. * Peophy, lactic antibiches IV should be
given before
dina skin incision..

I operative procedure * Anesthesia. - It may be spinal

(Epidural / General
J
. Supine *
Position of the patient - placed in dorsal position.
lii
 . in susceptible cases -> to minimize
venacada
... comperssion -> 150 tilt to L Sicka till
delive: * Anesthesia * Antiseptic painting - Abdomen is
painted a 7.5% povidons.
draping iodine solution / Saulon lotion of
to be properly draped e sterile
towels.
baby

*
Incision
mudian

b
of the abdomen - Veetical / Transverse incision
veetical - infraumbilical midline/para ent
Teansverse -
Pfannenstiel/3cm above

Doyen's retractor is introduced fra

Peritoneal cavity packed off e two taped
large swat
 * Packing

i
!!!!
lower flop
08.the
* Uteline inusion - 9 Peritoneal incision anal
loose peritoneums of uteovesical
pouch
cut transversely across the lower segna t &
lower flap of the peritoneum pushed a
L b muscle incision
Most commonly used incision-> Lowtransve
other type of uterine incisions are
au a)
Lower vextical 6 classical incision (upper
segment
Scanned with
CamScanner
2) Jincision
a
invested T incision.
 Low teansverse incision) & small transverse incision is made in the
midline
by a scalpel at a level slightly below peritoneal incision.
until the membranes of the sac are exposed. *two index
finger are then insented a muscles of the
lower segmacht are split transversely across the fibres. This
method minimizes blood loss but requires experience.
*个个个
Î
?
Delivery of the head. membeanes are ruptured it still
intact. - Blood mixed amniotic fluid is sucked out by
continuous
Doyen's retractor is removed. Head is delivered by hooking
the head é the fingers by elevation a flexion using the palm
As the head is drawn to the incision line, assistant is to
apply pressure on fundus. If the head is jammed assistant
may push up the head Head can also delivered by using
wigley's foriceps!! As soon as the head is delivered suction
of mucous ferm mouth,
. Trunk *
pharynx,
nostrils
& Delivery of the → After the
delivery of the shoulder - Oxqplocin 200 IV
1 Methergine 0.2mg ! Rest
of the body is deliver they placed in blw mother's thigh
Cord is clamped & cat aba
is handed over to
pediatrician
through
vagina
?
1↑*
or

mely baby is placed ha

9

*
< 90 sec.
Doyen's retractor is reintroduced) Optimum
interval blo uterine incision & delivery >90 sec
=> associated z pcoe APGAR Score'

Scanned with
CamScanner
ÎÎÎÎ
 * Removal of the placenta a membeane.
By this time, the placenta is separated Spontaneousle
→ Placenta is extracted by controlled cold teaction.
Routine manual lemoval should not be done .
Membeanes are caustully removed preferably intact if
small piece attached to decidua Should be removed
by
using a deyquazett
Exploration of the uterine Cavity is desirable.
/
* Suture of the uterine wound.
è the uterunt.
Suture of the caterine wound is done
in the abdomen
Margins of the wound' are picked up by Alli's tissue tacens
TG I one each for angle & one each for margin yuterine
incision is Sewed in 3 layers.
first layer - first stich in the lateral angle ē No: o chionis
s catgut fuiceye a round bodied needle.
we continuous running suture taking deeper
muscle posta l Stich is tied near the end of the angle

R
 . Similar continuous suture taking the
- superficial muscles & adjasunt facia 3rd
layer
2 Peritoneal flaps may be apposed by
- continuous inveeting suture (to peevent
any ra
amentary Scultura Non closure
of parietal z visceral peritonecem as
i peefeaed
Concluding part
i * mops placed inside are amoved a numbet verified.
Pecitoneal toileting is done & blood clots removed.
Tubes ? Ovaves are examined I Doyen's retractor is
removed on the
After being satisfied that the cuteus is well contracted, allow
is closed din layers. vagina is cleansed of blood clots of a sterile vuhal
pad is placed
Scanned with
CamScanner
 .. 5
to IL

wore than average cü sostou

I Post operative care
first aahe
observation * Monitor BP, PR, Teme every to help for
1st2 his then
R, Temp every Inhaly for 1st 2 has then and
help for 6-8 hrs. x o
. * Check for amount of vaginal bleeding & be haviour of
citeren
fluid NS /RL 2 to 2.5L BT it blood loss is more than helpful
in anemic mother for a speedy post operative recovery.
Oxytocics. Oxytocin 50 IMIV Methergine 0.2 mg IM
Peophylactic antibiotics. Les Cephalosporin &
Metronidazole 2-4 doses.
Analgesics. Pethidine hydrochlorida 75-long Ambulation.
 hurt to encouraged to move legs & ankles a breathe
deeply to minimize lequein Thrombosis & Pulmonary
embolism. Baby is put to breast for feeding after 3-4 her
com IV: OR
2 steret
oxy

‫اس‍‍ي‬
local feeding - plain electrolyte water | Rawtea.
Active bouce sounds are seved by the end of the day. Day 2
er en solid dit
ot ipa's choice
it needed.
lactulose @ bedtime
Bowel
care - 3.4 tsp of
 Scanned with
CamScanner
Suture
removal
on D-5 - Transverse
D-6- Longitudinal.
to

Sischarge Pt is discharged aften suture removal It may be

discharged as early as ged day to as later
Ith
post
speech

Complications of cs.
complications are either due to. <
tang
Anesthesia
Maternal complications may be < Irska
operative
post operative
Intraoperative complications D Extension of
uteine incision
t h e moshage/broad
ligament
 ot henistonen
» Uterine lacerations - may extend leantecalley. Lirferionly
into waga 3 Bladdie injury t h A Weeteral injury
at man 3 GIT injury 6
Hemophage - due to utine atony / lacerations. .
Morbid adherent placenta (placenta accuta)
Post operative complications. Immediate
T Remote
Immediate day wil Remote PPH
10
Gynecological
1 Gynecological p menstrual
excuss fingulos
to choonic pelvic
pain 2 Shock
Backach
e
T
!
 Anesthetic hazards
' 2 General Surgical T
"
ต) () (60
Infections
I General Surgical Incisiond herna
Intestinal
obstante 3
-
Intestinal obstruction
due to adhesions.

obur Thromboembolic discedes 3 future peignancy - scar

rupture
wound complications.
Scanned with
CamScanner
 fetal - Iatrogenic peenaturity & development of RDS. Maternal
3 Perinatal Mortality.
maternal
i to 1%
and loans
het
is
fetal
to 10.4
5
causes of den
causes of death
Hemophage & Shock collabot. *
Anesthetic hazard * Infection in *
Thromboembolic disorder
Classical os - pa 55
ik Asphyxia
* ROS *
Prematurity *
Infection
 Cesaran Hy
sterectomy
where
Cesarean hysterectomy enfees to an operation csis
followed by umoval of citaus.
Indication : D Mobid adherent
placenta 2 Atonic uterus & uncontrolled
Ppt
3 Big fibroid
+ Extensive laceration due to extension of tear & becad ligament
5) Geossly, inter
su intected ateaus
6 Ruptured atceuson

Scanned with
CamScanner