Cesarean section
O B J E C T I V E :-
Introduction
Definition
Types
Indication
Complication
Technique
Management
I N T ROD UC T I
O N:-
Caesarean section, also known as C-section, or
caesarean delivery, is the use of surgery to deliver
babies. A caesarean section is often necessary when
a vaginal delivery would put the baby or mother at risk.
D E F I N I T I O N :-
"A surgical
procedure involving incision of the walls of
the abdomen and uterus for delivery of offspring."
T Y P E :-1. ACC. TO TIMING
It is devied into 2 type. (A)ELECTIVE
(B)EMERGENCY
(A)ELECTIVE :- A caesarean section (c-section) is an operation
where a doctor makes a cut in your abdomen and womb and lifts
your baby out through it. If you know you will need a c-section before
you go into labour, this is called a elective planned c- section.
(B)EMERGENCY:- If labour has already begun, and a
complications begin, then an emergency c- section is performed.
2. ACC. TO UTERINE INCISION
It is further divide into 2 type:-
(A) Lower segment Caesarean section
(B) Upper segment Caesarean section
LSCS USCS
1. Incision make 1. Incision make
3 cm. above the above umbilicus & below
symphysis pubis. fundus part.
2. Less amount blood loss.
2.High amount blood loss.
3. Less chances to hernia.
3.High chances to hernia.
4. High cosmetic value.
5. Better healing process 4.Less cosmetic value.
occur
5.Healing process delay.
INDICATION:- A Caesarean section
is performed for a variety of indications. The
following are the most common :-
Breech presentation (at term) – planned
Caesarean sections for breech presentation at
term.
Other malpresentations – e.g. unstable lie transverse lie or oblique lie.
Twin pregnancy – when the first twin is not a cephalic presentation.
Maternal Medica conditions (e.g. cardiomyopathy)
Where labour would be dangerous for the mother.
Transmissible disease (e.g. poorly
controlled HIV).
Placenta praevia – ‘Low-lying placenta’ where
the placenta covers, or reaches the internal os
of the cervix.
Maternal diabetes- witha baby estimated
to have a fetal weight >4.5 kg.
Complications
:-
Lung aspiration.
Pulmonary embolus.
Postpartum haemorrhage.
Infection: being overweight and obesity are
significant risk factors for infection post-caesarean.
Longer stay in hospital may lead to difficulties
in bonding and adjustment difficulties for the
mother
and the rest of the family.
Techni que:- "During Delivery"
(A).The skin incision is done along the skin folds. (B).
The fascia are dissected above pyramidalis
muscles.(C). The uterotomy is done using blunt
Forceps & scissors. (D). The baby is “born” by
Expandingthe uterine wound using the fingertips
tothe
cranially push
edges of the wound.
"AFTER DELIVERY"
(A).The first suture stitch is placed slightly medially from the anatomical corner of
the wound. The same suture thread is used to make 2–4 more continuous sutures
and the ends of the suture thread are knotted. (B).Analogously a second suture
thread is used to close the uterine wall starting from the other side. (C).Both
sutures are knotted in the
Management:-
PRE-OPREATIVE:-
In preparation of patient C-section, you will be asked to Dr. & do the following:
(a) Provide a hospital gown and send a urine sample to lab.
(b) Have an intravenous line (IV) started in patient's arm or hand.
Through this you will administrate necessary fluids and medications
as needed.
(c) Provide blood drawn test.
(d) Nurse may be give antacid medicine to neutralize stomach
acidity and relieve from heartburn.
(e) Clear surgical site prepared (shaved). Do not do this in advance.
(f) Be examined by your obstetrician and anesthesiology
specialist, and asked to sign a consent form.
INTRA-OPERATIVE:-
(a) Support and assist in positioning the patient
during insertion of spinal/epidural anaesthetic.
(b) For elective sections where appropriate fetal heart
checked prior to and following insertion of epidural/spinal
anaesthesia. Document in clinical record.
(c) For emergency sections monitoring of the fetal heart
is directed by the most senior obstetric doctor present.
(d) Assist with positioning of patient for
catheterisation and surgery.
POST-OPERATIVE
Transfer to postpartum ward when pt. Stable vital sign check 15 minutes for 1
hour, then check 4 hours.
Monitor intakes and outputs every 4 hours for 24 hours
Activity:
o Bed rest
o Supine for 8 hours after spinal anesthetic Standard Diet
o Nothing by mouth for 8 hours after cesarean
section
o Sips of water after 8 hour window Early Solid Diet Protocol
o Solid food within 8 hours of C-Section
oWell tolerated Intravenous fluids
Contact physician for :
1.Temprature
2.Heart rate respiratory rate.
3.Uterine output foleys catheter in place.
Medications:
1.Antibiotics medicine:
(A). Ceftriaxone
(B). Amoxicillin
2.Pain medicine:
(A). pethidin hydrochloride
(B). Motrin
3. Metachlor promide.
4.Iron Sulfate dosing based on
Postpartum Anemia.
5. Oxytocine
