Caesarean Section
PRATYUSH P KURUP
RAMAN PRATAP SINGH
OBJECTIVES
• Definition
• Types
• Indication
• Complication
• Technique
• Management
DEFINITION
• Delivery of a viable fetus through an incision in the
abdominal wall and intact uterus.
• It involves incision of the walls of the abdomen and
uterus for delivery of offspring.
TYPES
1. ACC TO TIMING
• It is divided into 2 type : (A) ELECTIVE
(B) EMERGENCY
ELECTIVE : C-section planned before going into labour
EMERGENCY : If labour has already begun, and
complications begin, then an emergency C-section is
performed.
2. ACC TO UTERINE SECTION
It is further divided into 2 types:
(A) Lower segment Caesarean section
(B) Upper segment Caesarean section
INDICATION
1. Previous caesarean section
2 Dystocia or dysfunctional labour (abnormalities
of powers, passage and passenger)
• Cephalopelvic disproportion
• Tumours complicating pregnancy
• Fetal macrosomia
• Malpresentations like brow and transverse lie and persistent mentoposterior
• Deep transverse arrest ·
• Abnormal uterine action
• Threatened rupture and obstructed labour .
3. Failed induction
4. Fetal distress and cord prolapse
5. Breech presentation (selected cases)
6. Other fetal indications
• Severe intrauterine growth restriction
• Multiple pregnancy (first twin nonvertex and monoamniotic
twins)
7. Antepartum haemorrhage
• Placenta praevia
• Abruptio placenta(live fetus at term or failure to respond to
amniotomy and oxytocin)
• Vasa praevia
8. Maternal problems
• Elderly nullipara
• Prolonged period of infertility or pregnancy following IVF
• Bad obstetric history
• Previous repair of nulliparous prolapse, stress
incontinence or fistula
• HIV complicating pregnancy
9. Caesarean section on maternal request
Most common indications (85%)
• Previous caesarean (most common)
• Dystocia
• Fetal distress
• Breech presentation
COMPLICATIONS
lntraoperative Complications
1. Primary Haemorrhage
2. Injury to Internal Organs : Bladder, Ureter, Bowels
3. Injury to Baby
4. Difficulty in delivery of head.
5. Anaesthetic complications
• Aspiration
• Mendelson's syndrome
• Hypotension
• Cardiac Arrest
Postoperative Complications
• Paralytic ileus
• Respiratory complications
• Infection, peritonitis and pelvic abscess
• Pelvic thrombophlebitis
• Deep vein thrombosis and pulmonary embolism
• Wound dehiscence
Late Sequelae
• Secondary postpartum haemorrhage
• Incisional hernia
• Scar endometriosis
• Vesicovaginal fistula
• Scar rupture in the next pregnancy
• Placenta praevia and adherent placenta in next
pregnancy
• Vesicovaginal fistula
Preoperative Testing and Preparation
• Hb , CBC, Viral screening,RBS, GUE,Renal function
• Prescribe antibiotics(A dose of Ampicilin or 1st generation
Cephalosporin)
• Assess risk for thromboembolic disease
• To reduce the risk of Aspiration pneumonitis : Empty
stomach, Give an antacid + Cimetidine IV for 1 hr before
CS.
• Women having CS with regional anaesthesia require an
indwelling urinary catheter to prevent an over distension
of bladder.
Pffansteil incision
THANK YOU
