1. Tayebeh gharibi Faculty of nursing&midwifery
CESAREAN SECTION
Tayebeh gharibi
Faculty of nursing&midwifery

2. TYPES OF CS Lower segment CS Classical CS
Indications for classical incision:
Transverse lie with SROM
Structural abnormality that makes lower segment approach difficult
Constriction ring with neglected labour
Fibroids in the lower segment
Ant PP & abnormally vascular lower segment
Mother dead & rapid delivery is required
Very preterm fetus in breech pres

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

4. INDICATIONS FOR EMERGRENCY CS
Abruptio placntae
Fetal distress
Failure to progress in the first stage of labour
Cord prolapse
Obstructed labour
Failed induction
Malpresentation  brow, face, shoulder & compound presentations, breech
Compromised fetus 2ry to DM, HPT, isoimmunization

5. اندیکاسیونهای مادری سرکلاژ دائمی دفرمیته لگن گسیختگی انسزیون رحمی
سابقه میومکتومی
توده های انسدادی ژنیتال
سرطان مهاجم سرویکس
بیماری قلبی یا ریوی
انوریسم مغزی
زایمان سزارین هنگام مرگ
ضایعاتی که مستلزم جراحی داخل شکمی همزمان هستند

6. اندیکاسیونهای مادری جنینی
عدم تناسب سری لگنی
شکست خوردن زایمان واژینال ابزاری
پلاسنتا پرویا ودکولمان

7. اندیکاسیونهای جنینی وضعیت غیراطمینان بخش نمایش غیرطبیعی ماکروزومی
ناهنجاری مادرزادی
نتیجه غیرطبیعی داپلر عروق بندناف
ترومبوسیتوپنی
سابقه ترومای زایمانی نوزادان قبلی

8. موربیدیتی نوزادان
پارگی پوست شایعترین سفالوهماتوم شکستگی جمجمه فلج عصب فاسیال سزارین پس از شکست زایمان واژینال ابزاری .بیشترین میزان اسیب کمترین میزان آسیب در سزارین الکتیو

9. TIMING OF ELECTIVE CS For maternal interest  no choice
For fetal interest consider maturity & fetal condition
Usually at 38 wks

10. 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 30 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

11. Catheterize the bladder
Tilt the mother 15 º by using wedge
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

12. COMPLICATIONS INTRAOPERATIVE Bleeding & the need for bl transfusion
Hysterectomy
Complications of anaesthesia
Damage to the bladder, ureter, colon , retained placental tissue
Fetal injury
POSTOPERATIVE
Gaseous distension
Paralytic ileus
Wound dehiscence & infection
Infectins  UTI, pulmonary
DVT & pulmonary embolism
Death
Vesico uterine fistula

13. 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

14. 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
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 Similar to the conduct of normal labour Observe for
Progress
Fetal wellbeing
Maternal well being
Cx may be ripened
Labour may be agumented
Epidural & other analgesics may be used
HOSPITAL SHOULD PROVIDE BLOOD , OPERATING ROOM 24 HRS, NEONATAL RESUSCITATION, NURSING ANAESTHESIA &SURGICAL PERSONNEL CAN START CS WITHIN 30 MIN

16. SCAR RUPTURE O.2-1.5% for LSCS 4-9% for classical
INDICATIONS OF SCAR RUPTURE
Fetal distress
Ease of fetal palpation
Cessation of contractions
Elevation of presenting part
Scar pain
Bleeding / shock

17. 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

18. 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

19. 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