CESAREAN SECTION

CS
 CESAREAN SECTION Cs

Ghadeer Al-Shaikh, MD, FRCSC

Assistant Professor & Consultant
Obstetrics & Gynecology
Urogynecology & Pelvic Reconstructive Surgery
 TYPES OF CS
 Lower segment CS
 Classical CS
 Indications for classical CS
 Transverse lie back down (with SROM)
 Structural abnormality that makes lower segment
approach difficult (Fibroids)
 Anterior Placenta Previa & abnormally vascular
lower segment
 Poorly developed lower segment in Very preterm
fetus in breech presentation
 Cervical cancer
 INDICATIONS FOR ELECTIVE CS
 Uterine CS
Repeat surgery eg. Hystrotomy, myomectomy
 PlacentaIUGR
Severe previa
 VV fistula repair
Breech
 HIV (poor
Multiple pregnancy
controlled)
 Active herpes
Transverse lie
 Fetal
Ca of macrosomia
the Cx/ TR obstructing
> 4500 gmthe birth canal
 INDICATIONS FOR EMERGRENCY CS

 Severe PET
 Abruptio placenta (APH)
 Fetal distress
 Failure to progress in the first stage of labour
 Cord prolapse
 Obstructed labour
 Failed induction
 Malpresentation  brow, chin post, shoulder &
compound presentations, breech
 Compromised fetus 2ry to DM, HPT,
isoimmunization
 TIMING OF ELECTIVE CS

 Usually at 38-39 wks

 Before Emergency CS
 Explain to the Pt & husband & obtain consent

 Inform anesthetist, OR staff, ped

 100% oxygen mask in case of fetal distress

 Sodium citrate 20 ml , metoclopramide 10 mg IV

 Transfer to the theatre, IV , take blood for Hb, x-

match 2 U of blood
 Preferable to use spinal or epidural anaethesia
 Catheterize the bladder
 Tilt the mother 15 º by using wedge
 Pneumatic inflatable boots or Ted stockings
 Prophylactic Ab ↓↓ incidence of infection
 Inform ped if the mother had opiates in the last 4
hrs
 Halothane should not be used uterine relaxation &
bleeding
 COMPLICATIONS

INTRAOPERATIVE
 Bleeding & the need for bl transfusion
 Hysterectomy
 Complications of anaesthesia
 Damage to the bladder, ureter, colon ,
retained placental tissue
 Fetal injury
 COMPLICATIONS

POSTOPERATIVE
 Paralytic ileus
 Wound dehiscence & infection
 Infectins  UTI, pnemonea
 DVT & pulmonary embolism
 Fistula
 Death
 POSTNATAL CARE
 V/S & blood loss must be monitered
 Uterine fundus palpated
 Effective parentral analgesics
 Deep breathing & coughing encouraged
 Early mobilization
 Fluid therapy &diet
 Bladder & bowel function
 Wound care
 Lab
 Breast care
 Prophylaxis for thrombembolism
 MODE OF DELIVERY IN NEXT
PREGNANCY
CRITERIA FOR VBAC
 Pt must agree to the procedure
 A low transverse uterine incision
 Non recurrent cause of the previous CS
 No macrosomia, malposition, multiple
gestation, breech
 MODE OF DELIVERY IN NEXT
PREGNANCY
Contraindication
 Previous classical CS
 2 or more previous CS
 Previous other uterine surgery
 Hx of scar rupture
 Placentaprevia or transverse lie
 CONDUCT OF LABOUR

Observe for
 Progress
 Fetal wellbeing

 Maternal well being

 Epidural
 HOSPITAL SHOULD PROVIDE BLOOD , OPERATING
ROOM 24 HRS, NEONATAL RESUSCITATION,
NURSING ANAESTHESIA &SURGICAL PERSONNEL
CAN START CS WITHIN 30 MIN
 Risk of SCAR RUPTURE
 O.5% for LSCS
 4-9% for classical
 SCAR RUPTURE

Signs OF SCAR RUPTURE

 Fetal distress

 Ease of fetal palpation

 Cessation of contractions
 Elevation of presenting part

 Scar pain
 Bleeding / shock
 ABNORMAL
LABOUR/DYSTOCIA/FAILURE TO
PROGRESS IN LABOUR

CAUSES

1-Abnormalities of the pasage

 Alteration in the shape of the pelvis

 Mass occupying the birth canal
 ABNORMAL
LABOUR/DYSTOCIA/FAILURE TO
PROGRESS IN LABOUR
2-Abnormalities in the passenger
 Abnormal lie
 Abnormal presentation

 occiput-postrior, occiput-transverse
brow
face
breech
 Macrosomia , perinatal mortality 5* higher than N
Wt
 Congenital malformation

 Multiple gestation
 ABNORMAL
LABOUR/DYSTOCIA/FAILURE TO
PROGRESS IN LABOUR
3-Abnormalities in the powers
 Ineffective uterine activity
 Lack of voluntary expulsive efforts in the 2nd stage

DYSTOCIA IS THE MOST COMMON INDICATION FOR

CS