CAESARIAN SECTION

 

CAESARIAN SECTION

                                                "  YET ANOTHER WAY TO GET OUT!!

 

Why Called so??

According to legend , julius caesar was born by this operation

 It was a fatal operation until beginning of 20th century

. Now the most common operation performed worldwide

 

 DEFINITION:

The delivery of a viable fetus through an incision in the abdominal wall and uterus.

 Definition does not include removal of fetus from abdominal cavity in case of rupture uterus . 

WHO recommends an ideal caesarean rate 15 20 % .

But in most countries it is 15-20 %

 

WHY RATES INCREASED ?

× Increase in repeat caesareans .

 × Difficult instrumental delivery and vaginal breech deliveries

 x Increased diagnosis of intrapartum fetal distress

x Caesarian on demand

x Identification of risk of mothers and fetuses

×Increase in pregnancies by invitro fertilization

 

INDICATIONS

× Previous caesarian section

×Dystocia or dysfunctional labour

x Fetal distress

×Breech presentation

×Antepartum haemorrhage

 ×Maternal problems

×Caesarian section on demand

 

LSCS

lower (uterine) segment Caesarean section

Cross matched blood

Catheter introduced

Antibiotic prophylaxis

 Heparin as thromboprophylaxis

Parts cleansed with antiseptic solution

Left lateral position- reduce aortocaval compression

                               . Reduce risk of supine hypotension

 

 

ANAESTHESIA

GA or REGIONAL

REGIONAL Spinal or Epidural

 Mendelson's syndrome- GA given as emergency- risk of aspiration- chemical pneumonitis .

To counteract- antacids given during labour , oral fluids withheld.

30 ml 0.3 molar sodium citrate orally -1/2 hr before surgery .

Sellick's manoeuvre- endotracheal intubation accompained by pressure on cricoid cartilage at the neck.

 

ABDOMINAL INCISIONS

 Pfannensteil incision - MC used .

• Transverse curvilinear incision above pubic hairline

•Deepened through s / c tissue upto rectus sheath

•Rectus sheath divided transversely

 

 

Maylard incision

 Option when more exposure is needed in transverse incision Recti muscles are divided Midline vertical incision

 

PROCEDURE

Once abdomen opened- dextrorotation of uterus corrected

Doyen retractor- visualize lower segment Peritoneum over lower segment identified divided transversely.

seperated from bladder by blunt dissection Small incision in lower segment - extended laterally

Inadequate space- J shaped or inverted T incision

Do not injure uterine vessels lying laterally.

 

DELIVERY OF BABY

Cephalic presentation

Hand slipped into uterine cavity

 Head is levered out gently

Floating head- use forceps to deliver the baby .

 

 

feet hooked out first

rest delivered as vaginal breech delivery

 

Transverse or oblique lie

corrected to longitudinal lie before making uterine incision.

Transverse lie with ruptured membranes & undeveloped lower segment

extension of uterine incision required.

 

 

CLOSURE OF UTERINE INCISION

x OXYTOCIN infusion started as soon as baby is delivered

x Uterine fundus contracts - placenta and membranes extrudes spontaneously removed ×Wipe with moist pad- ensure uterine cavity is empty and cervical canal is open

×Uterine edges- held with ALLIS forceps or GREEN ARMYTAGE forceps- incision closed in 2 layers- continuous sutures.

 

Chromic catgut or polyglactin used

 

•Any bleeding points- controlled with figure of - eight sutures

 

CLOSURE OF ABDOMEN

PERITONEUM. closed or not closed RECTUS SHEATH - non absorbable sutures proline- to reduce wound dehiscence & incisional hernia SUBCUTANEOUS TISSUE - closed

SKIN- mattress sutures of silk , subcuticcular suture or clips.