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PREVIOUS C.S.

PREVIOUS C.S. Pregnancy with history of previous C.S. is quite prevalent in present day obstetrics According to the statistics available the total cesarean rate has increased every year and in the year 2002 it was 26.1%

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PREVIOUS C.S.

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  1. PREVIOUS C.S.

  2. Pregnancy with history of previous C.S. is quite prevalent in present day obstetrics • According to the statistics available the total cesarean rate has increased every year and in the year 2002 it was 26.1% • Since the rate of primary C.S. has increased the most remarkable change in obstetric practice over the last decade is the management of the women with prior Cesarean delivery.

  3. Routine obstetric history Past surgical history • To ascertain functional and structural integrity of the scar • Selection of patients for VBAC Criterion for VBAC • No more than one prior low transverse cesarean delivery • Clinically adequate pelvis • No other uterine scars or previous rupture • Physician immediately available throughout active labour who is capable of monitoring labour and performing cesarean delivery • Availability of anesthesia and personnel for emergency C.S.

  4. RECURRENT CPD Previous classical C.S Previous two LSCS NON-RECURRENT Malpresentations Failed Induction Failure to progress APH BOH Hypersensitive disorders or associated complications To ascertain functional and structural integrity of the scar1.Indication for C.S.

  5. 2.Type ofC.S.

  6. Total number of C.S. done before • Time interval between successive pregnancy and LSCS • history of vaginal births after delivery • If operative notes are available Complications during surgery Type of incision, extension of incision Inverted T shaped incision Suturing method Single layered, two layered, three layered Suturing material used -catgut / vicryl • Post operative stay • Wound healing: Day of suture removal, Resuturing, infection of wound etc.

  7. History of associated present pregnancy complications Patient in labour • Pain in abdomen specially in supra pubic region • Vaginal bleeding • Bladder Tenesmus Haematuria • In scar dehisence -Various degrees of shock • Intelligent patient may say giving way sensation with decrease in pain and uterine contractions • Absence of fetal movements

  8. On Examination: Patient not in labour • Look for anemia, PIH • Type of incision - Pfennsteil incision / Vertical incision • Type of healing - Primary intension /Secondary Intension • Associated keloid formation, Incisional hernia Abdominal examination • Presence of Malpresentation, CPD, placenta previa • Estimated fetal weight

  9. Patient in labour • Signs of impending scar rupture Unexplained tachycardia Fall in blood pressure Fetal distress – abnormal FHS Bradycardia Tenderness over uterine scar Failure to progress in the course of labour without any apparent cause Ballooning of lower uterine segment

  10. In case of scar Dehisence • Patient may present with various degrees of shock • Signs of shock Early phase Tachycardia Excessive sweating Normal BP Intermediate phase Consciousness is altered Appears pale dehydrated with sweating Periphery cold Tachycardia Hypotension Urine output will be normal Late Patient may be in confusional state Pallor increases Tachycardia, thready pulse with low pulse volume Cold clammy extremities Oliguria Tachyopnoea Bleeding

  11. Abdominal examination • Fetal parts felt superficially • FHS absent • Uterus may be felt separately

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