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Caesarean Section

This document provides an overview of caesarean section (CS), including its definition, historical background, indications, contraindications, procedural details, complications, and conclusions. It defines CS as the delivery of the fetus, placenta, and membranes through an abdominal and uterine incision. The document traces the history and developments of CS, including early high mortality rates and modern refinements. It outlines various indications for and contraindications to CS, as well as preparation, procedural details like incision types, and potential complications. The conclusion emphasizes that the need for CS must outweigh risks and that adequate preparation and monitoring can help minimize complications.

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183 views

Caesarean Section

This document provides an overview of caesarean section (CS), including its definition, historical background, indications, contraindications, procedural details, complications, and conclusions. It defines CS as the delivery of the fetus, placenta, and membranes through an abdominal and uterine incision. The document traces the history and developments of CS, including early high mortality rates and modern refinements. It outlines various indications for and contraindications to CS, as well as preparation, procedural details like incision types, and potential complications. The conclusion emphasizes that the need for CS must outweigh risks and that adequate preparation and monitoring can help minimize complications.

Uploaded by

IdiAmadou
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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CAESAREAN SECTION

DR DOHBIT SAMA
DEPT. OBS/GYN
FMBS, UY I.

PLAN
1.

Definition
2. Historical note
3. Indications and contraindications
4. Preparation for caesarean section
5. Procedural details
6. Types of caesarean section
7. Complications and prognosis
8. Conclusion

DEFINITION
It

is the delivery of the foetus, the placenta


and membranes through an incision in the
abdominal and uterine walls.
This excludes the obsolete operation of
vaginal caesarean section
It also excludes the recovery of foetus in
abdominal pregnancy and uterine rupture

DEFINITION 2
Operation

for delivery of a previable infant is


hysterotomy
The first caesarean is known as primary,
subsequent ones are secondary, tertiary etc
or simply as repeat caesarean
An elective c/s is one that is done before the
onset of labour or any complication that may
constitute an urgent indication

HISTORICAL NOTE
Many

controversies on this term.


Nothing to do with the birth of Julius Caesar
Suggested to be linked to the lex caesar
which was a decree from the time of Numa
Pompilius through the caesars (715 - 672
BC), requiring that no woman at late
pregnancy should be buried with the dead
foetus in her womb.

HISTORICAL NOTE 2
Probably

derives from the Latin word


caedere to cut.
First documented operation was in 1610, she
died on Day 25th post operative
Mortality was 50 85%
First successful c/s in the U. S. was in 1794
Initially no sutures and no antibiotics were
used.

HISTORICAL NOTE 3
Porro

in 1876 excised the corpus of the


uterus and stitched the cervix unto the lower
edge of the incision wound
Scanger in 1882 sutured the uterine defect in
a Classical incision.
LUSCS by Osiander in1805, modified by
Frank in 1906.

HISTORICAL NOTE 4
DeLee

emphasized on the advantages of the


LUSCS over the scanger classical though he
met with many criticisms.
PRM above 12 hours was a strict
contraindication to c/s, some recommened
craniotomy on the living baby
Exceptionally, extraperitoneal c/s was done

HISTORICAL NOTE 5
Today,

refinements in surgical technique,


asepsis, antibiotic therapy, blood transfusion
and anaesthesia have reduced the risks
associated with c/s

GENERAL CONSIDERATION
The

rate of c/s has risen from 5 to 20% in the


past 20 years; previous scar, approach to
breech, electronic monitoring
Maternal mortality from c/s varies from 4 to 8
per 10.000
The risk of death from c/s is 26 times greater
than that from vaginal delivery

INDICATIONS
Indicated

where vaginal delivery is not


feasible or would impose undue risks on
mother or baby
Some are clear and absolute, others are
relative
In some cases, fine judgment is needed to
determine whether vaginal delivery or
caesarean section would be better

INDICATIONS 2
Cephalopelvic
Uterine

Disproportion

Inertia
Placenta praevia
Premature placenta separation
Malposition and malpresentation
Preeclampsia-Eclampsia
Foetal distress

INDICATIONS 3
Cord

prolapse
Diabetes, Erythroblastosis, and other
threatening conditions
Carcinoma of the cervix
Cervical dystocia
Previous uterine incision

OTHER INDICATIONS
Tumour

praevia
Prior extensive vaginal plastic operation
Active herpes genitalis
Severe heart disease
Pregnancy following IVF

CONTRAINDICATIONS
Absence

of an appropriate indication
Pyogenic abdominal wall infections
An abnormal foetus
A dead foetus
Lack of appropriate facility or assistants

PREPARATION
Ultrasound

examination; number, position,


size, R/O gross abnormality, determine the
position of the placenta
Timing; foetal maturity, no off hour operations
Blood if deemed necessary; PEC, HELLP,
coagulopathy etc
IV line, antacid, Foley, shaving, antisepsis

PROCEDURAL DETAILS
Prophylactic

antibiotics given after cord

clamp
Anaesthesia could be general or locoregional
Position on the table; Trendenlenburg, left
lateral tilt etc
Abdominal incisions; transverse, midline

PROCEDURAL DETAILS 2
Uterine

incisions
Heavy bleeders stopped with adequate
forceps
Avoid the placenta as much as possible, in
order to avoid foetal blood loss
Delivery of baby, placenta and the uterus!!

TYPES OF CAESAREAN
Classic:

easiest but greater blood loss and


risk of rupture, intestinal obstruction.
Used in PP, transverse lie, premature
deliveries
LUSCS
Extraperitoneal caesarean section

COMPLICATIONS
Blood

loss, amniotic fluid spillage


Anaesthetic and surgical complications
Wound healing and infections
Risk of rupture, 4-9% in classic scars and
0.2-1.5% in LUSCS scars
2x risk of maternal death from c/s than
vaginal delivery

COMPLICATIONS 2
Perinatal

morbidity and mortality: safe


vaginal delivery in a multipara would be
better for the baby than in a repeat elective
c/s
Iatrogenic prematurity
Respiratory problems
Incidental operations must be reconsidered

CONCLUSION
The

need for caesarean section must over


weigh the potential risks before the
procedure is performed
Adequate preparation is always necessary in
order to minimize complications
Postoperative monitoring very essential
The ultimate goal is to obtain a healthy and a
happy mother and child

THANK YOU

MERCI

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