1. CESAREAN SECTION CS

2. CESAREAN SECTION Cs Ghadeer Al-Shaikh, MD, FRCSC
Assistant Professor & Consultant
Obstetrics & Gynecology
Urogynecology & Pelvic Reconstructive Surgery

3. TYPES OF CS
Lower segment CS
Classical CS

4. 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

5. INDICATIONS FOR ELECTIVE CS
Repeat CS
Placenta previa
VV fistula repair
HIV (poor controlled)
Active herpes
Fetal macrosomia > 4500 gm
Uterine surgery eg. Hystrotomy, myomectomy
Severe IUGR
Breech
Multiple pregnancy
Transverse lie
Ca of the Cx/ TR obstructing the birth canal

6. 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

7. TIMING OF ELECTIVE CS
Usually at wks

8. 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

9. 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

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

11. COMPLICATIONS POSTOPERATIVE Paralytic ileus
Wound dehiscence & infection
Infectins  UTI, pnemonea
DVT & pulmonary embolism
Fistula
Death

12. 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

13. 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

14. 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

15. 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

16. Risk of SCAR RUPTURE
O.5% for LSCS
4-9% for classical

17. SCAR RUPTURE Signs OF SCAR RUPTURE Fetal distress
Ease of fetal palpation
Cessation of contractions
Elevation of presenting part
Scar pain
Bleeding / shock

18. 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

19. 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

20. 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