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Understanding Cesarean Section: Types, Indications, and Complications

This informative guide delves into the different types of cesarean sections, their indications, complications, and postnatal care. It also discusses the criteria for vaginal birth after cesarean and the conduct of labor in subsequent pregnancies.

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Understanding Cesarean Section: Types, Indications, and Complications

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  1. CESAREAN SECTION CS

  2. CESAREAN SECTION Cs Ghadeer Al-Shaikh, MD, FRCSC Assistant Professor & Consultant Obstetrics & Gynecology Urogynecology & Pelvic Reconstructive Surgery

  3. TYPES OF CS • Lower segment CS • Classical CS

  4. Indications for classical CS • Transverse lie back down (with SROM) • Structural abnormality that makes lower segment approach difficult (Fibroids) • Anterior Placenta Previa & abnormally vascular lower segment • Poorly developed lower segment in Very preterm fetus in breech presentation • Cervical cancer

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

  6. INDICATIONS FOR EMERGRENCY CS • Severe PET • Abruptio placenta (APH) • 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

  7. TIMING OF ELECTIVE CS • Usually at 38-39 wks

  8. 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

  9. 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

  10. COMPLICATIONS INTRAOPERATIVE • Bleeding & the need for bl transfusion • Hysterectomy • Complications of anaesthesia • Damage to the bladder, ureter, colon , retained placental tissue • Fetal injury

  11. COMPLICATIONS POSTOPERATIVE • Paralytic ileus • Wound dehiscence & infection • Infectins UTI, pnemonea • DVT & pulmonary embolism • Fistula • Death

  12. 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

  13. 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

  14. MODE OF DELIVERY IN NEXT PREGNANCY 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 Observe for • Progress • Fetal wellbeing • Maternal well being • Epidural • HOSPITAL SHOULD PROVIDE BLOOD , OPERATING ROOM 24 HRS, NEONATAL RESUSCITATION, NURSING ANAESTHESIA &SURGICAL PERSONNEL CAN START CS WITHIN 30 MIN

  16. Risk of SCAR RUPTURE • O.5% for LSCS • 4-9% for classical

  17. SCAR RUPTURE Signs OF SCAR RUPTURE • Fetal distress • Ease of fetal palpation • Cessation of contractions • Elevation of presenting part • Scar pain • Bleeding / shock

  18. 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

  19. 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

  20. 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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