Caesarean Section

Ghaida’a Alaraj M.S

At Balqa’a Applied Unevirsity

A caesarean section is a surgical procedure in which incisions are made through a woman’s abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies.

History :

Caesarean section considered to be one of the oldest operations in Greak. date back to India , Egypt, Roman and the history of medicine

Included 15th century performed only when the mother was dying or dead, (as was the religious custom). It was not meant to save the mother’s life . In Great Britain and Ireland, the mortality rate in 1865 was 85%. until the 19th century that steps to improve the chances of survival of the mother were successfully made. This included the usage of anesthesia , surgical asepsis (carbolic acid introduced by Joseph Lister), better equipment ) and uterine sutures Following these changes, surgeons were able to focus on improving incisions made to the uterus. Advocated by British obstetrician Munro Kerr, between 1880 and 1925, transverse incisions of the lower aspect of the uterus were found to reduce infections and uterine ruptures in pregnancy

Key Steps In Reducing Mortality

At Caesarean Section:

1•Adherence to principles of asepsis. .

2•Extraperitoneal caesarean section and then moving to low

transverse incision.

3•Anaesthetic advances.

4•Blood transfusion.

5•Antibiotic treatment and prophylaxis.

Cesarean Section

There are three theories about it :

.11.Derived from theory is that the name for the surgical procedure comes from

.2the Roman decree requiring the babies of dead or dying pregnant women to be Caesarea Lexknown as the lawof part cut from the womb, which was

.32. Derived from an ancient story, told in the 1st century by Pliny the Elder, who claimed that an ancestor of Caesar was delivered in this way.

3. An alternative etymology suggests that the procedure’s name derives from the Latin verb caedere, to cut.

INCIDENCE :

•it is the most common operation performed worldwide.

•Increased incidence worldwide during last 25 years. Why !

WHY RATES INCREASED?

1-Caesarian on demand

2-Increase in repeat caesareans.

3-Identification of risk of mothers and fetuses

4-increase maternal morbidity and complications

•Advantages •1-Safest method of birth if

maternal or fetal

• health is compromised

• by a vaginal delivery

•2-Fetal birth trauma is rare

•Disadvantages •1-Postoperative

complications

•2-long recovery period

CLASSIFICATION

•Elective

•Emergency .

Elective caesarean scheduled caesarean section for procedure that are planned ahead of time during daytime hours.

All other caesarean sections can be classified as emergency, irrespective of whether the woman was in labor or not.

The degree of urgency should be described clearly using a standard classification to ensure that there is effective communication between the members of the multidisciplinary team, particularly the theatre staff, anaesthetist and obstetrician

CLASSIFICATION SYSTEM FOR Emergency of CAESAREAN SECTION Category 1: Immediate threat to life of woman or fetus Category 2: No immediate threat to life of woman or fetus Category 3: Requires early delivery Category 4: At a time to suit the woman and maternity services

•MAJOR INDICATIONS: •The four major indications

accounting for greater than 70% of operations are:

••Previous caesarean section.

•• Malpositions (mainly breech).

••Failure to progress in labor.

••Suspected fetal compromise in labor.

•RELATIVE INDICATIONS •Fetal distress in first stage of labor

•Poor past obstetric history.

•Malpresentations: brow.

•Malpositions: transverse lie, breech.

.

• ABSOLUTE INDICATIONS:

•Absolute CPD

•higher grades of placenta praevia.

No list can be truly comprehensive so the overriding principle is that whenever the risk to the mother and/or the fetus from vaginal delivery exceeds that from abdominal delivery, a caesarean section should be undertaken.

CESAREAN DELIVERY ON MATERNAL REQUEST (CDMR) : an elective cesarean in the absence of any medical or obstetric contraindication for attempting vaginal delivery. It needs to differentiate between women who request caesarean section because of a previous traumatic birth experience (e.g. emergency caesarean section, difficult OVD )and women who request caesarean section because they wish to avoid labor. There is also increasing recognition of a condition termed ‘tocophobia’, which describes an irrational fear of childbirth that can be very incapacitating for the woman.

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