6586511 Caesarean Section

8/12/2019 6586511 Caesarean Section

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CAESAREAN

SECTION. BY DR.

ADDAH A. O.

DEFINITION: Caesarean section is the delivery of a fetusthrough an abdominal and uterine incision after the 28thee!

of gestation"NOTE: Non# surgical means of e$%ulsion of the fetus&embryo from the uterine cavity as in uterine ru%ture orro%ture of an ecto%ic %regnancy is not included" Theo%eration for such condition is !non as '()(*OTO+,"


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HISTORICAL PERSPEDTIVE

Origin controversial. H!ot"esise# to $e na%e# a&ter t"e %anner o& $irt" o& '(li(s

Caesar in )** BC. Originall (se# to #eliver t"e $a$ o& a %ot"er +"o "a# #ie# in

ancient Eg!t, Asia AND E(ro!e. -irst caesarean section on a live +o%an +as t"at on t"e +i&e o&'aco$ N(&er in t"e )t"cent(r.

Earliest re!ort o& a c"il# t"at s(rvive C/S +as t"e $irt" o&0orgias o& Sicil in 1* BC.

T"e !roce#(re +as associate# t"en +it" "ig" %ortalit #(e tose!sis 3 lac4 o& anti$iotics5 an# t"ere +as no anaest"esia.

0reat i%!rove%ent an# s(rvival &ro% t"e )6t"cent(r es!eciall+it" t"e a#vent o& t"e lo+er seg%ent C/S BY 7(nro 8 9err.


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inci#ence

In+est A&rica )1 8 2) ;.

In


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Preo!erative !re!eration.

A &(ll "istor an# !"sical e>a%ination. Past %e#ical an# s(rgical "istor. C(rrent %e#ications. H> o& #r(g allergies.

In#ication &or t"e C/S. Consent &or t"e s(rger. La$orator investigations 8 PCV,


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Preo!erative !re!aration

cont#.Pre 8 %e#ication +it" antaci# is

stan#ar#.

Pro!"latic anti$iotics $e&ore t"es(rger.


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In#ication -or C/S,

7ATERNAL INDICATIONS Severe !re? ecla%!sia +it" (n&avo(ra$le

cervi> &or vaginal #eliver. 3a$sol(te5 Previo(s classical caesarean #eliver.

3a$sol(te5 . Previo(s e>tensive (terine s(rger +it"

entr into t"e (terine cavit eg

%o%ecto%. O$str(ctive !elvic t(%o(rs eg &ri$oi#s,

ovarian csts.


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7aternal in#ications &or C/S

cont#.Previo(s :*!erineal tears.

Previo(s s(ccess&(l V V - re!air

3 a$sol(te5.V(lva "er!es si%!le>.


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-ETAL INDICATIONS -OR

C/S. -etal #istres.

A$nor%al !resentations 8 $reec", $ro+

3a$sol(te5, !ersistent occi!ito 8 !osteriorin la$o(r, &ace +it" %ento 8 !osterior.

A$nor%al lies 8 transverse, o$li(e,

7(lti!le gestations 8 tri!lets an# "ig"er

or#er gestations. -etal %acroso%ia 8 +eig"t greater t"an

=1**g.


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-etal in#ications &or C/S cont#.

-ootling $reec",

. Ver lo+ $irt" +eig"t 8 3 less t"an

)1**g5. -etal a$nor%alit 8"#roce!"al(s,

conoint t+ins, s!ina $a&i#a.


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7ATERNAL 8 -ETAL

INDICATIONS -OR C/S.Ce!"alo!elvic #is!ro!ortion.

Dstocia 8arrest o& cervical #ilatation or

&ail(re o& #escent o& !resenting !art.7aor #egree !lacenta !raevia.

Placental a$r(!tion +it" a live &et(s.

A$sol(te !elvic #is!ro!ortion.


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S9IN INCISIONS -OR C/S

S4in incicions co(l# $e vertical or

transverse. Bot" "ave a#vantages an#

#isa#vatages.Vertical incisions 8

7i#line s($ 8 (%$ilical incision 3%ost

co%%onl (se# s4in incision in 3ten#ing a$ove t"e

(%$ilic(s.

Para%e#ian.


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Vertical incisions cont#.

ADVANTA0ES

Less vasc(lar, less "ae%orr"age.

0ives goo# e>!os(re o& $ot" !elvic an#a$#o%inal organs.

Ver (se&(l in e%ergencies #(e to s!ee#

an# ease o& t"e !roce#(re.

DISADVANTA0ES 8 !rone to "ernia&or%ation an# evisceration ris4.


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Transverse s4in incisions.

P&annenstiel 3%ost !o!(lar5.

A#vantages

E>cellent cos%etic a!!earance. Less ris4 o& +o(n# #e"iscence.

Earl a%$(lation.

Less ris4 o& "ernia &or%ation.

Disa#vantages.

Ta4es longer ti%e to !er&or%.


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Transverse s4in incisions cont#.

7a res(lt in in(r to ileo 8 ing(inal an# ileo 8"!ogastric nerves.

Increase# $loo# loss.

Cohen incision8 It is a straig"t transverse incision 8 anterior rect(s

s"eat" incise# in t"e %i#line &ollo+e# $ $l(nt#issection.

+aylard incision8 3


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is

o& t"e (ter(s in t"e %i#line.


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Classical incision

In#ications. Preter% #eliver +it" !oorl &or%e# lo+er

seg%ent. Placenta !raevia +it" large vessels in

lo+er seg%ent. Pre%at(re r(!t(re o& %e%$ranes, !oor

lo+er seg%ent an# transverse lie. Transverse lie +it" $ac4 in&erior. Large cervical &i$roi#. Post%orte% C/S.


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A#vantages o& transverse lo+er

(terine incisions over classical

incision Less ris4 o& entr into (!!er (terine seg%ent.

0reat ease o& entr.

Less ris4 o& a#"esion &or%ation to $o+el oro%ent(%.

Less li4eli"oo# o& (terine r(!t(re in s($se(ent!regnancies.

VBAC is !ossi$le.

Less intra? o!erative $lee#ing. NOTE THAT CLASSICAL C/S ARE NOT

RO


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A#vantages o& classical incision

over lo+er seg%ent incision.Ra!i# entr into t"e (ter(s.

No lateral e>tensions into t"e (terine

vessels an# $roa# liga%ent. I& lo+er seg%ent is !oorl #evelo!e#,

#eliver $ classical C/S is

a#vantageo(s +it"o(t lateral e>tension.

Eas entr into t"e (ter(s +"en t"ere is

&i$roi# in t"e lo+er seg%ent.


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Anaest"esia -or C/S.

0eneral anaest"esia.

Regional anaest"esia.

S!inal. E!i#(ral

AVOID -


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CO7PLICATIONS O- C/S.

Hae%orr"age +"ic" %a lea# to anae%ia.

In(r to %aternal organs 8 $la##er, $loo#

vessels, (ter(s, $o+el.

In(r to neonate.

o(n# in&ection.

Dee! vein t"ro%$osis.

En#o%etritis. 7aternal %ortalit.

Anaest"etic co%!lications.

6586511 Caesarean Section

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