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CESAREAN SECTION

TYPES OF CS. Lower segment CSClassical CSIndications for classical incision:Transverse lie with SROMStructural abnormality that makes lower segment approach difficultConstriction ring with neglected labourFibroids in the lower segmentAnt PP

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CESAREAN SECTION

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    1. CESAREAN SECTION DR. SALWA NEYAZI CONSULTANT OBSTETRICIAN GYNECOLOGIST PEDIATRIC & ADOLESCENT GYNECOLOGIST

    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 Severe PET Abruptio placntae 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 APH

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

    6. 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

    7. 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

    8. 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

    9. 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

    10. 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

    11. 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

    12. 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

    13. 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

    14. 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

    15. 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

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