• • • • • Definition Type of caesarean section Comparing both types Indication Preparation and procedure for caesarean section • complication

DEFINITON OF CAESAREAN SECTION • Operative procedure • To deliver fetus/baby • Via transabdominal .

Munro Kerr introduce lower segment incision. .Brief history • Caesarean  believe take from Julius caesar who deliver via an operation  caesar= kizar(latin) mean to cut • Classically they been done through vertical incision • 1920s.

vertical incision 2. Uterine incision .pfannenstiel incision: suprapubic.lower segment incision (transverse) . transverse incision . Skin incision .midline incision: below umbilicus until just above symphisis pubis.classsical incision(vertical) .Type of caesarean section Classified by type of incision 1.

patient with previous midline scar .patient with ovarian cyst .post mortem caesarean section .• Lower segment incision usually done after lower segment of uterus is well formed >28 weeks • Vertical skin incision done if quick access to abdomen is required such as in cord prolapse and also done in: .

Higher risk of uterine rupture in subdequent pregnancy Does not give access to presenting part Upper part of uterus involve in postpartum involution .lower risk of uterine rupture in subsequent pregnancy Ready access to presenting part Lower part of uterus does not involve in pospartum involution .Low risk of bleeding intraoperatively Lower part of uterus not active (not conttract & retract) during labour Very vascular and thick part .High risk of bleeding intraoperatively Upper part of uterus is active ( contract & retract) during labour .The suture tend to loose and poor heal .Classical vs lower segment cut LOWER SEGMENT INCISION CLASSICAL INCISION Avascular part .The suture can heal well .

Preterm delivery less than 28 weeks . Tranverse lie fetus with the back at inferior part of uterus 3. Post mortem caesarean section 6.adhesion between bladder and uterus 2. Plan to proceed with radical hysterectomy (for cervical carcinoma ) after delivery the baby 5. Placenta previa or abruptio placenta which the great vessel at lower part 4.fibroid at lower uterus . if lower segment of uterus is not accessible .When to perform classical incision 1.

Failed instrumental delivery 6.INDICATION • EMERGENCY LSCS 1. Cephalo-pelvic disproportion / dystocia 3. Placenta praevia with significant bleeding 8. Abruptio placenta 5. Fetal distress (commonest) 2. Eclampsia and severe pre eclampsia . Failed induction of labour ( poor progress of labour despite time and induction was given) 7. Umbilical cord prolapse 4.

Breech presentation 5. 1 previous classical caesarean section incision 4. cephalo-pelvic dispropotion 2.which fetus may not withstand stress of labour 6. 2 or more previous LSCS scars 3. Obstructed passage by tumor(eg. fibroid or cervical carcinoma . Intrauterine growth restriction .INDICATION • ELECTIVE LSCS 1.

Elderly primigravida(especially who has history of long subfertility) .> 35 years old * not absolute indication 8. malpresentation/ malposition 10.7. Multiple pregnancy 9. Uncontrolled diabetes mellitus and hypertension . Mother with genital herpes and HIV 11.

Pre operative preparation • Consult patient about the decision of performing caesarean section • Take consent • Set intravenous line for mother • Put in urinary catheter • Order blood • Monitor mother and fetus closely • Call anesthesiology and paediatrician .

midline vertical incision .Intra operative procedure • Anaesthesia .lower segment incision .epidural/ spinal .general (especially in emergency) • Incision .

Lower segment anatomy .

• Delivery of baby .

• Clamp cord • Delivery of placenta ( continuous cord traction) .

• Closing the suture .

COMPLICATION • Anaesthesia complication .aspiration / Mendelson’s syndrome(aspiration of acidic content of gastric content) especially in general anaesthesia for emergency caesarean section .

• Surgical complication 1. Thromboembolism 2. Infection 4. Injury to bladder and ureter . Bleeding 3. Poor wound healing 5.

fetus weight via ultrasound 2.Care and caution for spontaneous delivery careful estimation if mother wish for vaginal delivery 1.High risk of scar dehiscence and uterine rupture in subsequent labour . Pelvic capacity : erect lateral pelvicmetry(ELP) anterior posterior diameter for inlet and outlet of pelvic cavity is favourable if > 11.5cm .• Obstetric complication(later) .

• If they are allowed for vaginal delivery. close monitoring sign and symptom of scar dehiscence or uterine rupture  pain between contraction(at lower abdomen) Tender over the scar  mother is tachycardia and/or hypotension  exessive per vaginal bleeding  poor progress of labour  fetal distress  may associated with haematuria( due to adhesion of previous scar to wall of bladder) .

Vaginal delivery in patient with 1 previous scar • Succession rate :70% • Risk of scar rupture: 0.5% (1 in 200) • High cautios should be taken if require induction as it will increase risk of scar rupture to 3% # patient with 2 previous scar should not be allowed for vaginal delivery .